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目的探讨C臂-X光引导下经皮肾微造瘘弹道碎石术(miniPCNL)治疗肾、输尿管上段结石的疗效。方法C臂-X光引导下行mPCNL术共370例,其中肾结石208例,输尿管结石65例,肾、输尿管结石97例。结果术后2周超声随访,370例患者中358例(96.76%)结石完全清除(包括术后II期PCNL66例),10例(3.24%)有残余小结石。并发症包括:术后反复出血4例(1.08%),3例经介入治疗治愈,1例行肾切除并术后诊断为肾盂癌;合并结肠损伤3例(0.81%),2例保守,1例行结肠修补和人工肛造口术均治愈;1例(0.27%)水中毒,经处理治愈,1例(0.27%)胸腔积液,行胸腔闭式引流术后治愈。结论经皮肾微造瘘弹道碎石术对于治疗肾结石和输尿管上段结石效果良好,具有创口小,术后恢复快,美容等优点;对于复杂性肾结石可以短期内(一周内)再次手术,有较高的取石率,适合在基层医院推广应用。
Objective To investigate the effect of C-arm-X-guided miniPCNL on renal and ureteral calculi. Methods C arm-X-guided mPCNL surgery a total of 370 cases, of which 208 cases of kidney stones, 65 cases of ureteral stones, kidney and ureteral stones in 97 cases. Results Two weeks after operation, 358 cases (96.76%) of 370 patients had complete removal of calculi (including 66 cases of postoperative stage II PCNL) and 10 cases (3.24%) had residual small calculus. Complications included 4 cases (1.08%) of recurrent bleeding after operation, 3 cases cured by interventional therapy, 1 case with nephrectomy and renal pelvic cancer after operation, 3 cases (0.81%) with colonic injury, 2 cases conservative Routine colon repair and artificial anal ostomy were cured. One case (0.27%) of water poisoning was cured by treatment and one case (0.27%) of pleural effusion was cured after closed thoracic drainage. Conclusion Percutaneous renal micro-fistulae lithotripsy is effective in treating stones in the upper and upper ureteral calculi. It has the advantages of small wounds, quick recovery after surgery, beauty and so on. For complex renal calculi, reoperation can be performed within a short period of time (within one week) A higher rate of stone, suitable for promotion and application in primary hospitals.