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目的探讨斜仰截石位经皮肾镜取石术(PCNL)治疗上尿路结石的安全性和有效性。方法 2009年9月～2011年6月,采用斜仰截石位PCNL治疗上尿路结石36例,其中肾结石24例,输尿管上段结石合并肾盏结石7例,单纯输尿管上段结石5例。患者取斜仰截石位,垫高患侧肩和臀部使身体倾斜30°～45°。超声引导经腋后线12肋下或11肋间穿刺肾脏建立通道。采用气压弹道碎石行1次或分次清除结石。结果 36例患者中31例一期PCNL清除结石,1次碎石成功率为86.1%。5例复杂性肾结石因残石行二期清石。平均手术时间为(96±19)min。无肠道或胸膜损伤等并发症发生。结论采用斜仰截石位PCNL治疗上尿路结石安全有效、操作方便,有利于患者生理状态下的呼吸、循环及碎石块的冲出和麻醉监测,可明显提高患者手术耐受性,值得临床推广应用。
Objective To investigate the safety and effectiveness of percutaneous nephrolithotomy (PCNL) in the treatment of upper urinary tract calculi. Methods From September 2009 to June 2011, 36 cases of upper urinary tract calculi were treated by PCNL with oblique inclinations, including 24 cases of renal calculi, 7 cases of upper ureteral calculus with calyceal calculus, and 5 cases of simple ureteral calculi. Patients take oblique stone position, padded shoulder and hips so that the body tilt 30 ° ~ 45 °. Ultrasound guided through the axillary line 12 ribs or 11 intercostal puncture the kidney to establish access. Pneumatic lithotripsy line 1 or graded clear stones. Results Of the 36 patients, 31 cases of primary PCNL cleared stones and the success rate of primary gravel was 86.1%. 5 cases of complex kidney stones due to residual stone row two stone. The average operation time was (96 ± 19) min. No intestinal or pleural injuries and other complications occurred. Conclusions The PCNL is safe and effective in the treatment of upper urinary tract calculi. It is easy to operate and can be used to monitor the respiration, circulation and gravel block outflow and anesthesia monitoring in patients with physiological status. It can significantly improve the patient’s tolerance to surgery. Clinical application.