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目的:探讨微创经皮肾通道碎石(Minimally Invasive Percutaneous Nephrolithotomy,mPCNL)与改良经皮肾通道碎石治疗复杂上尿路结石的临床疗效。方法:回顾性分析2003年10月至2009年2月经皮肾镜碎石术治疗上尿路结石430例,据术中建立的碎石通道将其分为mPCNL组(220例)和改良经皮肾通道组(210例),分析其术中出血量、手术时间、结石清除率、术后感染率、胸腹腔积液等指标。结果:mPCNL组和改良通道PCNL组均于术后24h复查血红蛋白分别下降(28±6)g/L,(30±5)g/L。其中术中或者术后输血者各为12例和11例,两组各有一例因术后大出血而行超选择动脉栓塞治愈。mPCNL组手术时间90~180 min平均为120 min。改良通道PCNL组手术时间50~150 min平均为90 min。结石清除率mPCNL组84.5%而改良通道PCNL组达到94.8%,两组残余结石均经二期、三期取石或者体外碎石排出。其中mPCNL组与改良通道PCNL组损伤胸腹膜者各有3例。术后发生尿路感染分别有28例和25例,经选用敏感抗生素治疗3~5天体温降至正常。结论:采用改良经皮肾通道治疗复杂性上尿路结石能明显缩短手术时间,提高结石取净率并不增加出血、感染、胸腹腔损伤等并发症。
Objective: To investigate the clinical efficacy of Minimally Invasive Percutaneous Nephrolithotomy (mPCNL) and modified percutaneous nephrolithotripsy in the treatment of complex upper urinary tract calculi. Methods: From October 2003 to February 2009, 430 cases of upper urinary calculi were treated by percutaneous nephrolithotomy. According to the intraoperative established gravel channel, they were divided into mPCNL group (220 cases) and modified percutaneous The renal access group (n = 210) was enrolled in this study. The intraoperative blood loss, operation time, stone clearance rate, postoperative infection rate, pleural effusion and other indicators were analyzed. Results: The levels of hemoglobin in the mPCNL group and the modified channel PCNL group decreased by (28 ± 6) g / L and (30 ± 5) g / L, respectively. Among them, intraoperative or postoperative transfusions were performed in 12 cases and in 11 cases, one case in each group was cured by superselective arterial embolization due to postoperative hemorrhage. The operation time of mPCNL group was 120 min for 90-180 min. The modified channel PCNL group operation time of 50 ~ 150 min averaged 90 min. The stone clearance rate was 84.5% in the mPCNL group and 94.8% in the modified channel PCNL group, and the remaining stones in both groups were discharged through the second stage, the third stage or the extracorporeal gravel stones. The mPCNL group and the modified channel PCNL group had 3 cases of thoracoabdominal and peritoneum respectively. Postoperative urinary tract infections were 28 cases and 25 cases, the choice of sensitive antibiotics to 3 to 5 days the body temperature dropped to normal. Conclusion: The improved percutaneous renal access to the treatment of complicated upper urinary tract stones can significantly shorten the operation time and improve the recovery rate of stones without increasing the complications of hemorrhage, infection, thoracic and abdominal cavity injury.