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目的:探讨经皮肾微创治疗无积水肾结石患者的临床疗效。方法:回顾性分析2009年8月～2011年3月我院采用经皮肾镜取石术微创治疗210例无积水肾结石患者。改进人工肾积水的方法,行患侧输尿管逆行插入双J管,留置尿管,利用膀胱持续灌注通过双J逆流制造人工肾积水;超声联合X线引导下穿刺目标肾盏,建立经皮肾通道行微创经皮肾镜取石术。对手术时间、结石清除率、手术并发症等临床资料进行分析。结果:208例患者均1期穿刺成功,204例成功施行1期单通道取石,4例完全性鹿角型结石患者,因结石较大,患者年龄较大,存在基础疾病,手术时间超过2h,改为2期手术取石;2例患者术中出血穿刺失败,中转开放手术。195例患者1期1次手术取净结石;3例患者2次经皮肾镜取石术取净结石;2例患者残留结石配合ESWL加药物排石治疗,术后1～3个月复查无结石残留,总结石清除率95.2%(200/210)。手术时间60～130min,平均75min。3例患者术中出血较多,输血400～600ml。无气胸、周围脏器副损伤等严重并发症发生。结论:采用改进制造人工肾积水的方法,在超声联合X线引导下行微创经皮肾镜取石术,治疗无积水肾结石,具有穿刺成功率高、手术时间短、结石清除率高、手术并发症少等优点,是微创治疗无积水肾结石的首选方法。
Objective: To investigate the clinical effect of minimally invasive percutaneous nephrolithotomy in patients with hydronephrosis. Methods: A retrospective analysis from August 2009 to March 2011 in our hospital with percutaneous nephrolithotomy minimally invasive treatment of 210 cases of patients with hydronephrosis. To improve the artificial hydronephrosis method, retrograde ipsilateral ureter insertion of double J tube, indwelling catheter, the use of continuous perfusion through the bladder double J counterflow manufacturing artificial hydronephrosis; ultrasound combined with X-ray guided puncture the target calyx, the establishment of percutaneous Renal access minimally invasive percutaneous nephrolithotomy. The operation time, stone clearance rate, surgical complications and other clinical data were analyzed. Results: All of the 208 patients were successfully performed stage 1 puncture, 204 cases were successfully treated with stage 1 single-channel stone and 4 cases with complete antler stone. The patients were older and had underlying diseases. The operation time was longer than 2 hours For the two surgical stone; 2 patients with intraoperative bleeding failure, transit open surgery. One case of 195 patients was treated with neo-stone one time, two patients with nephrolithotomy were treated by nephrolithotomy in three patients, two patients with residual stones combined with ESWL plus drug therapy, one to three months after operation Residues, the total stone clearance rate of 95.2% (200/210). Surgery time 60 ~ 130min, an average of 75min. 3 patients bleeding more blood transfusions 400 ~ 600ml. No pneumothorax, peripheral organ damage and other serious complications. Conclusion: The method of improving the manufacture of artificial hydronephrosis, minimally invasive percutaneous nephrolithotomy guided by ultrasound combined with X-ray treatment of hydronephrosis, with high success rate of puncture, short operative time, high rate of stone clearance, Fewer complications and other advantages of minimally invasive treatment of hydronephrosis is the preferred method of kidney stones.