【摘要】 目的 探討微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石的方法及療效。 方法 2007年9月-2010年10月在B型超聲引導(dǎo)下應(yīng)用微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石138例，其中腎鹿角形結(jié)石64例，單發(fā)腎盂、腎盞結(jié)石38例，雙腎結(jié)石8例，輸尿管上段結(jié)石28例，孤立腎結(jié)石2例。 結(jié)果 136例取石成功，其中95例一期取石成功（包括雙通道取石5例），41例二期取石，2例因經(jīng)皮腎穿失敗改行開放手術(shù)取石。27例術(shù)后體外震波碎石治療。平均結(jié)石清除率78.9%（109/138）。平均手術(shù)時(shí)間112 min，平均住院時(shí)間10 d，腎造瘺管平均留置時(shí)間4 d，雙J管平均留置時(shí)間4周。5例因術(shù)中出血較多需輸血。11例術(shù)后1周內(nèi)出血較多，其中3例需要輸血。12例出現(xiàn)尿外滲。7例術(shù)后出現(xiàn)高熱（ gt;39 ℃）。隨訪: 98例伴有腎積水，時(shí)間3~6個(gè)月，平均4個(gè)月，24例積水消失，68例積水減輕，6例無改善也無加重；22例殘余結(jié)石隨訪4~9個(gè)月，平均6個(gè)月，6例結(jié)石增大，16例結(jié)石無變化；87例隨訪12個(gè)月無殘余結(jié)石，7例結(jié)石復(fù)發(fā)。 結(jié)論 微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石創(chuàng)傷小，恢復(fù)快，并發(fā)癥少，療效滿意。
【Abstract】 Objective To discuss the method and the curative effect of minimally invasive percataneous nephrolithotomy (mini PCNL) with holmium laser in treating upper urinary tract calculi. Methods From September 2007 to October 2010, 138 patients with upper urinary tract calculi were treated with mini PCNL with holmium laser under the conduction by type-B ultrasonography. Of the 138 cases, 64 patients had staghorn calculi, 38 had single renal pelvis or renal calyx stones, eight had bilateral renal calculi, 28 had upper-ureteral calculi, and two had solitary kidney calculi. Results Successful stone removal was achieved in 136 cases, among which there were 95 cases of stage-one nephrolithotomy (double tracts were used in five cases) and 41 cases of sfage-two neploolithotomy. Two cases were changed to open operation due to failures of percutaneous nephrolithotory. Extracorporeal shock-wave lithotomy was used in 27 cases after operation. The average stone removal rate was 78.9% (109/138). The average operation time was 112 minutes. The average hospital stay was 10 days. The average nephrostomy tube stay was four days. The average double J tube stay was four weeks. Five patients needed blood transfusion in operations due to a large amount of blood loss. Eleven patients suffered from massive hemorrhage one week after operation and blood transfusion was performed in three patients. Urine exosmosis happened in 12 cases. And there were seven cases of high fever ( gt;39 ℃) after operation. Follow-up was done for 98 patients accompanied by hydronephrosis for a time period ranged from three to six months averaging at four months. Hydronephrosis disappeared in 24 patients, alleviated in 68 cases, and did not change in six cases. Twenty-two cases of residual calculi were followed up for a period ranged from four to nine months averaging at six months. Enlarged calculi occurred in six cases and no change happened to the calculi in 16 cases. Eighty-seven patients without residual calculi were followed up for 12 months, and there were seven cases of reoccurrence. Conclusion Treatment of upper urinary tract calculi with minimally invasive percutaneous nephrolithotomy with holmium laser is a simple and safe method with little injury, quick recovery, few complications and satisfactory results.
引用本文： 石濤,張小平,張大虎,郭永連,陳懷波. 微創(chuàng)經(jīng)皮腎鏡下鈥激光碎石術(shù)治療上尿路結(jié)石. 華西醫(yī)學(xué), 2011, 26(4): 528-531. doi: 復(fù)制
| 1. | Fernstrom I, Johannson B. Percutaneous nephrolithotomy: a new extraction technique[J]. Urol Neohol, 1976， 10(3): 257-260. |
| 2. | 吳開俊, 李遜, 袁堅(jiān), 等. 經(jīng)皮腎微造瘺術(shù)后二期經(jīng)皮腎輸尿管鏡取石術(shù)治療鹿角形結(jié)石[J]. 廣州醫(yī)學(xué)院報(bào), 1993, 21: 13-16. |
| 3. | 李遜, 曾國(guó)華, 吳開俊, 等. 微創(chuàng)經(jīng)皮腎穿刺取石術(shù)治療上尿路結(jié)石[J]. 臨床泌尿外科雜志, 2003, 18(9): 516-517. |
| 4. | 李遜, 曾國(guó)華, 袁堅(jiān), 等. 經(jīng)皮腎穿刺取石術(shù)治療上尿路結(jié)石(20年經(jīng)驗(yàn))[J]. 北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2004, 36(2): 124-126. |
| 5. | 高新. 微創(chuàng)泌尿外科手術(shù)與圖譜[M]. 廣州: 廣東科技出版社, 2007: 21-22. |
| 6. | Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries[J]. Endourol, 2005, 19(1): 54-57. |
| 7. | 孫穎浩, 高小峰, 王林輝, 等. 大功率鈥激光經(jīng)皮腎鏡取石術(shù)治療腎結(jié)石[J]. 中華外科雜志, 2005, 43(18): 1209-1211. |
| 8. | 余兆雄, 楊榮叔, 蔡勇, 等. 大功率鈥激光經(jīng)皮腎微造瘺輸尿管鏡治療復(fù)雜性腎結(jié)石[J]. 臨床泌尿外科雜志, 2009, 24(10): 766-767. |
| 9. | 曾國(guó)華, 李遜, 吳開俊, 等. 微創(chuàng)經(jīng)皮腎鏡取石術(shù)治療輸尿管上段結(jié)石[J]. 中華泌尿外科雜志, 2003, 24(10): 671-672. |
| 10. | 李遜, 徐桂彬, 何永忠, 等. 微創(chuàng)經(jīng)皮腎取石術(shù)治療孤立腎鑄型結(jié)石的療效觀察[J]. 臨床泌尿外科雜志, 2009, 24(9): 653-655. |
| 11. | 楊文增, 師曉強(qiáng), 齊麗麗, 等. MPCNL治療上尿路結(jié)石并發(fā)癥的防治[J]. 臨床泌尿外科雜志, 2009, 24(11): 859-860. |
| 12. | Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study[J]. J endourol, 2004, 18(8): 715-722. |
| 13. | Vignal C, Lonzi S, Bargellini I, et al. Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization[J]. Eur Radiol, 2004, 14(4): 723-729. |
- 1. Fernstrom I, Johannson B. Percutaneous nephrolithotomy: a new extraction technique[J]. Urol Neohol, 1976， 10(3): 257-260.
- 2. 吳開俊, 李遜, 袁堅(jiān), 等. 經(jīng)皮腎微造瘺術(shù)后二期經(jīng)皮腎輸尿管鏡取石術(shù)治療鹿角形結(jié)石[J]. 廣州醫(yī)學(xué)院報(bào), 1993, 21: 13-16.
- 3. 李遜, 曾國(guó)華, 吳開俊, 等. 微創(chuàng)經(jīng)皮腎穿刺取石術(shù)治療上尿路結(jié)石[J]. 臨床泌尿外科雜志, 2003, 18(9): 516-517.
- 4. 李遜, 曾國(guó)華, 袁堅(jiān), 等. 經(jīng)皮腎穿刺取石術(shù)治療上尿路結(jié)石(20年經(jīng)驗(yàn))[J]. 北京大學(xué)學(xué)報(bào)(醫(yī)學(xué)版), 2004, 36(2): 124-126.
- 5. 高新. 微創(chuàng)泌尿外科手術(shù)與圖譜[M]. 廣州: 廣東科技出版社, 2007: 21-22.
- 6. Goel R, Aron M, Kesarwani PK, et al. Percutaneous antegrade removal of impacted upper-ureteral calculi: still the treatment of choice in developing countries[J]. Endourol, 2005, 19(1): 54-57.
- 7. 孫穎浩, 高小峰, 王林輝, 等. 大功率鈥激光經(jīng)皮腎鏡取石術(shù)治療腎結(jié)石[J]. 中華外科雜志, 2005, 43(18): 1209-1211.
- 8. 余兆雄, 楊榮叔, 蔡勇, 等. 大功率鈥激光經(jīng)皮腎微造瘺輸尿管鏡治療復(fù)雜性腎結(jié)石[J]. 臨床泌尿外科雜志, 2009, 24(10): 766-767.
- 9. 曾國(guó)華, 李遜, 吳開俊, 等. 微創(chuàng)經(jīng)皮腎鏡取石術(shù)治療輸尿管上段結(jié)石[J]. 中華泌尿外科雜志, 2003, 24(10): 671-672.
- 10. 李遜, 徐桂彬, 何永忠, 等. 微創(chuàng)經(jīng)皮腎取石術(shù)治療孤立腎鑄型結(jié)石的療效觀察[J]. 臨床泌尿外科雜志, 2009, 24(9): 653-655.
- 11. 楊文增, 師曉強(qiáng), 齊麗麗, 等. MPCNL治療上尿路結(jié)石并發(fā)癥的防治[J]. 臨床泌尿外科雜志, 2009, 24(11): 859-860.
- 12. Kukreja R, Desai M, Patel S, et al. Factors affecting blood loss during percutaneous nephrolithotomy: prospective study[J]. J endourol, 2004, 18(8): 715-722.
- 13. Vignal C, Lonzi S, Bargellini I, et al. Vascular injuries after percutaneous renal procedures: treatment by transcatheter embolization[J]. Eur Radiol, 2004, 14(4): 723-729.