【摘要】 目的探讨F26通道经皮肾镜碎石术(percutaneous nephrolithotomy,PCNL)治疗复杂性肾结石的安全性和有效性。方法 2006年6月~2013年6月对257例复杂性肾结石行PCNL,常规建立F16皮肾通道,输尿管镜确认后再扩张置入F26肾镜行碎石治疗。结果一期F26通道PCNL 135例,二期103例,三期19例。单通道155例,多通道102例。手术时间(87.6±47.5)min。术中、术后出血至血红蛋白持续下降接受输血12例。术后发热27例,对症抗感染治疗1~3 d后体温正常。未出现尿漏、器官损伤、感染性休克等严重并发症。出院时结石清除率86.7%(223/257),34例残留结石中,15例4~6mm残留结石行药物排石治疗,19例7~15 mm残留结石术后21~55 d(平均35.3 d)行ESWL,其中16例术后2.5月复查彩超或腹部平片证实结石已清除,术后2.5月结石清除率93.0%(239/257)。结论 F26通道PCNL治疗复杂性肾结石疗效安全可靠,可获得高的结石清除率。更多还原

【Abstract】 Objective To investigate the effects of F26 tract percutaneous nephrolithotomy( PCNL) for complex renal calculi.Methods A total of 257 patients diagnosed as having complex renal calculi from June 2006 to June 2013 were treated with PCNL. A F16 percutaneous renal access was routinely established,then was dilated to introduce a F26 nephroscope for PCNL. Results The procedure was accomplished by one-stage in 135 cases,two-stage in 103 cases,and three-stage in 19 cases. There were 155 cases of single tract procedure and 102 cases of multiple tract procedure. The average operative time was( 87. 6 ± 47. 5) min. Twelve patients suffered from massive hemorrhage intra- or post-operatively,who were managed by blood transfusion. There were 27 cases of fever after operation,who were cured by symptomatic and anti-infective therapy for 1- 3 days. No urine leakage,renal insufficiency,septic shock,or other complications occurred. The stone-free rate was 86. 7%( 223 /257) at discharge. Among the 34 cases of residual stones,drug administration for stone removal was conducted in 15 cases with 4- 6 mm stones,and an auxiliary ESWL was given at21- 55 d( mean,35. 3 d) after PCNL in 19 cases with 7- 15 mm stones,16 of which obtained free of stones confirmed by ultrasonography or X-ray examination at 2. 5 months after PCNL. The stone-free rate was 93. 0%( 239 /257) at 2. 5 months after PCNL. Conclusion F26 tract PCNL is effective and safe for complex renal calculi,with a high stone-free rate.更多还原