微创经皮肾镜取石术治疗轻度积水小体积肾结石的有效性和安全性

发布时间：2018-05-22 08:22

  本文选题：微创经皮肾镜取石术 + 肾结石　； 参考：《广州医科大学》2014年硕士论文

【摘要】：目的：探讨B超引导下微创经皮肾镜取石术（MPCNL）治疗伴有轻度肾积水的小体积（直径1～2cm）的肾结石或输尿管上段结石的有效性和安全性。 病人与方法：前瞻性分析2012年3月～2013年9月由我科同一位医生主治的90例直径1～2cm的伴有轻度肾积水的肾结石或输尿管上段结石患者，均于俯卧位下行B超引导下微创经皮肾镜取石术。对通道建立、手术时间、术中术后并发症及结石清除率进行临床分析。 结果：90例患者均在B超引导下成功建立经皮肾通道。87例患者顺利完成I期MPCNL，，3例因脓肾、心肺功能欠佳行I期造瘘、II期取石。穿刺时间5～15min，平均7±2.1min；手术时间为10～80min，平均40±15.6min。I期MPCNL术后复查有80例（88.9%）结石清除，其中结石完全清除72例，临床无意义残余结石8例；有临床意义残余结石10例，分别行II期MPCNL、体外冲击波碎石（ESWL）和内科排石。并发症发生率为20％（18/90），包括感染发热（T＜38.5℃3例、T≥38.5℃2例）、术后出血、血红蛋白显著降低3例、轻度疼痛7例，中重度疼痛需要镇痛处理者3例，住院期间未发生脏器损伤、尿瘘、血气胸等其它并发症。 结论：B超引导下微创经皮肾镜取石术治疗伴有轻度肾积水的1～2cm肾结石或者输尿管上段结石是安全和有效的，成功率、取石率高，并发症可接受。B超引导下微创经皮肾镜取石术是治疗此类结石的重要方法之一。
[Abstract]:Objective: to evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) guided by B-ultrasound in the treatment of renal calculi with mild hydronephrosis (1: 2 cm in diameter) or upper ureteral calculi. Patients and methods: from March 2012 to September 2013, 90 1~2cm patients with mild hydronephrosis or upper ureteral calculi were analyzed prospectively. Minimally invasive percutaneous nephrolithotomy under the guidance of B-ultrasound was performed in prone position. Clinical analysis was made on channel establishment, operation time, intraoperative and postoperative complications and stone clearance rate. Results under the guidance of B-ultrasound, all 90 patients were successfully established the percutaneous renal passage. 87 patients completed stage I MPCNL successfully. 3 patients with stage I MPCNL underwent stage II lithotomy because of pyonephrosis and poor cardiopulmonary function. The mean time of puncture was 7 卤2.1 min (mean 7 卤2.1 min), the operative time was 10 min (80 min) and the average time was 40 卤15.6min.I (80 cases) after MPCNL.) among them, 72 cases were completely removed, 8 cases were clinically meaningless residual stones, 10 cases had clinical significance residual stones. Stage II MPCNL, extracorporeal shock wave lithotripsy (ESWL) and internal lithotomy were performed. The incidence of complications was 20: 18 / 90, including infection fever T < 38.5 鈩

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