【摘要】 目的探讨斜向下经上盏入路微通道经皮肾镜取石术(mini-percutaneous nephrolithotomy,MPCNL)处理复杂性肾结石的应用价值。方法在带有穿刺架的B超引导下,于第11肋间采用穿刺针斜向下角度穿刺并建立经肾上盏的通道,行MPCNL治疗45例复杂性肾结石。结果 42例一次性经肾上盏穿刺成功。上盏穿刺单通道取石40例,上盏并中盏或下盏穿刺通道取石5例。手术时间45~120 min,平均72 min。无胸膜、结肠损伤,无大出血、感染性休克、明显胸腹痛等,3例术后出现发热,经抗感染、对症治疗后好转。37例无结石残留者术后5~8 d拔除肾造瘘管,平均5. 3 d;术后住院6~9 d,平均6. 5 d;术后一次性结石清除率82. 2%(37/45)。8例残余肾结石包括马蹄肾结石1例,后位结肠肾结石1例,鹿角形肾结石3例,多发肾结石3例,其中二次MPCNL清除结石4例,体外震波碎石排净结石2例,2例放弃进一步治疗。32例随访3~12个月,平均8. 5月,无结石复发,无肾造瘘口漏尿和感染,无继发性大出血。结论斜向下经上盏MPCNL治疗复杂性肾结石,并发症少,取石效率高,是一种安全、有效的术式。更多还原

【Abstract】 Objective To explore the value of mini-percutaneous nephrolithotomy( MPCNL) via oblique downward upper calyx approach for the treatment of complex renal calculi. Methods Under the guidance of ultrasound probe which equipped with a puncture frame,through the 11 th intercostal space,a puncture needle was passed into the upper calyx of kidney at an oblique downward angle to establish the access for MPCNL. A total of 45 cases of complex renal calculi were performed with MPCNL.Results Among the 45 patients,42 were successfully punctured through the upper calyx at one time. There were 40 cases of MPCNL through the single upper calyx and 5 cases of MPCNL through the upper calyx combined with the middle or the lower calyx. The operation time was 45-120 min( mean,72 min). No pleura or colon injury,massive bleeding,septic shock,or chest and abdominal pain happened. Three cases of fever were recovered after the treatment of anti-infection. The nephrostomy tube was extracted on 5-8 d( mean,5. 3 d) postoperatively in 37 cases without residual calculi. The postoperative hospital stay was 6-9 d( mean,6. 5 d). The postoperative calculi clearance rate was 82. 2%( 37/45). Among 8 patients with residual renal stones,there were 1 case of horseshoe renal calculi,1 case of posterior colonic renal calculi,3 cases of staghorn renal calculi,and 3 cases of multiple renal calculi. There were 4 cases of secondary MPCNL,2 cases of extracorporeal shock wave lithotripsy,and 2 cases of abandonment of further treatment.A total of 32 cases were followed up for 3-12 months,with an average of 8. 5 months. There was no recurrence of calculi,leakage of urine and infection of nephrostomy orifice,or secondary massive hemorrhage. Conclusion MPCNL with oblique downward upper calyx approach is a safe and effective method for the treatment of complex renal calculi,with fewer complications and high calculi removal efficiency.更多还原