【摘要】 目的评价"无管化"微通道经皮肾镜取石术MPCNL治疗上尿道结石临床的安全性和有效性.方法应用"无管化"MPCNL方法治疗上尿路结石患者42例,其中肾结石患者23例和输尿管上段结石19例,结石最大直径均≤3 cm.术中结合X线检查残留结石.术后不留置肾脏造瘘管,留置导尿管1～2 d后拔除,双"J"管术后10～14d拔除.结果 42例患者术中出血量约30～90mL,平均60mL,未出现肾脏集合系统穿孔及大出血;手术时间30～70 min,平均45 min.所有患者均一次性取出结石,结石清除率为100%(42/42);术后未出现尿漏、肾周血肿、感染等并发症;术后住院时间4～7 d,平均(5.3±1.1)d.出院后1个月和3个月复查,无结石复发,肾周无肾性囊肿,肾积水均不同程度减轻.结论 "无管化"MPCNL方法治疗上尿路结石安全有效、结石清除率高、并发症少、术中出血量少、手术时间短、患者恢复快,有一定的临床应用价值,值得推广应用.更多还原

【Abstract】 Objective To evaluate the safety and efficacy of tubeless microchannel percutaneous nephrolithotomy(MPCNL).Methods From March 2003 to May 2008,42 patients with upper urinary calculi were treated with tubeless MPCNL.Among them,there were 23 cases of renal calculi,19 cases of upper ureteric calculi.The max diameter of calculi was on more than 3 centimeter.with X-ray was used in operation to assure whether there was residual of calculi or not.Nephrostomy tube was not placed at the end of operation,but catheter and double-pigtail stent were placed in operation and removed within 1 to 2 days and 10 to 14 days respectively.Results There were no hemorrhea and perforation in all kidney collective systems.blood loss of patients was 30～90 mL(average 60 mL),the operation time was 30～70 minute(average 45 minute).All the 42 cases were one-staged stone removal,the stone-free rate was 100 percent(42/42).Of all the patients,there were no complications such as urine leakage,perirenal hematoma and postoperative infection.The hospital stay after operation was from 4 to 7 days,mean time was(5.3±1.1)day.There was no recurrence of calculi,hydronephrosis was lessened by different degree following up 1 and 3 months.Conclusions The tubeless MPCNL is suitable for selected patients.The operative method is safe and effective,there is no discomfort due to the placement of a nephrostomy,furthermore,the postoperative hospital stay is decreased.The value of tubeless MPCNL for the clinical application should be further evaluated.更多还原