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目的:探讨微创经皮肾镜取石术(mPCNL)治疗肾结石和输尿管上段结石的方法及效果。方法:分析我院2009年11月～2012年11月自主开展的mPCNL 336例。结果:男206例,女130例,年龄16～80岁,平均年龄(47.6±12.1)岁。左侧上尿路结石141例,其中左肾结石93例,左输尿管上段结石20例,左肾结石合并左输尿管上段结石28例;右侧183例,其中右肾结石127例,右输尿管上段结石31例,右肾结石合并右输尿管上段结石25例;双侧上尿路结石12例,其中3例肾结石合并对侧输尿管上段结石,5例双肾结石,4例双侧输尿管上段结石。其中肾铸型结石33例,肾脏多发性结石86例,孤立肾结石6例。结石1.5～7.0cm大小不等,平均(3.1±1.4)cm。336例一期均成功建立经皮肾镜微创通道,手术时间30～240 min,平均(117.0±42.1)min。1例中转开放切除患肾。1例中转开放取石。67例患者一次碎石不完全,有结石残留>8 mm。8例患者一次碎石效果不满意,二次经皮肾镜碎石,其中6例结石清除完全。6例患者术后1周内发生急性大出血,均保守治疗成功。1例通道经过胸膜腔,用凡士林纱布填塞瘘道后吸收愈合。其中145例采用“无管化”。本组无腹腔脏器损伤等严重并发症。总结石取尽率为81.8%。结论:MPCNL治疗肾结石及(或)合并输尿管上段结石安全、有效,具有创伤小,恢复快等优势。
Objective: To explore the method and effect of minimally invasive percutaneous nephrolithotomy (mPCNL) in the treatment of upper calculus of the kidney stones and ureters. Methods: 336 cases of mPCNL independently developed in our hospital from November 2009 to November 2012 were analyzed. Results: There were 206 males and 130 females, aged from 16 to 80 years and mean age (47.6 ± 12.1) years. The left upper urinary tract stones in 141 cases, including 93 cases of left kidney stones, left upper ureteral stones in 20 cases, left renal calculi with upper left ureteral stones in 28 cases; right 183 cases, including 127 cases of right kidney stones, right upper ureteral stones There were 31 cases of right kidney stones with 25 cases of upper right ureteral stones, 12 cases of bilateral upper urinary tract stones, 3 cases of renal calculi with contralateral ureteral calculi, 5 cases of double renal calculus and 4 cases of bilateral ureteral calculi. Of which 33 cases of kidney mold stones, kidney stones in 86 cases, isolated kidney stones in 6 cases. Stones 1.5 ~ 7.0cm in size, the average (3.1 ± 1.4) cm. A total of 336 patients underwent minimally invasive percutaneous nephrolithotomy. The operation time ranged from 30 to 240 minutes (mean, 117.0 ± 42.1) min. 1 case of transfer removed open kidney. 1 case of transfer open stone. 67 cases of patients with an incomplete gravel, residual stones> 8 mm. 8 patients were not satisfied with the results of a gravel, secondary percutaneous nephrolithotomy, of which 6 cases of complete removal of stones. Six patients developed acute hemorrhage within one week after surgery, and conservative treatment was successful. One channel through the pleural cavity, filled with vaseline gauze fistula after healing. 145 cases of which use “no control ”. This group has no serious complications such as abdominal organ injury. The total stone extraction rate was 81.8%. Conclusion: MPCNL is safe and effective in the treatment of renal calculi and / or upper ureteral calculi. It has the advantages of less trauma and faster recovery.