Modified Percutaneous Nephrolithotomy for Treatment of Complexity Upper Urinary Calculus_West China Medical Journal

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Department of Urology tThe Central Hospital of Suining City,Suining Sichuan 629000,China;

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Keywords：

改良經皮腎通道; 經皮腎通道; 并發癥

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目的:探討微創經皮腎通道碎石(Minimally Invasive Percutaneous Nephrolithotomy, mPCNL)與改良經皮腎通道碎石治療復雜上尿路結石的臨床療效。方法:回顧性分析2003年10月至2009年2月經皮腎鏡碎石術治療上尿路結石430例,據術中建立的碎石通道將其分為mPCNL組(220例)和改良經皮腎通道組(210例),分析其術中出血量、手術時間、結石清除率、術后感染率、胸腹腔積液等指標。結果: mPCNL組和改良通道PCNL組均于術后24h復查血紅蛋白分別下降(28±6) g/L,(30±5) g/L。其中術中或者術后輸血者各為12例和11例,兩組各有一例因術后大出血而行超選擇動脈栓塞治愈。mPCNL組手術時間90~180 min平均為120 min。改良通道PCNL組手術時間50~150 min平均為90 min。結石清除率mPCNL組84.5%而改良通道PCNL組達到94.8%,兩組殘余結石均經二期、三期取石或者體外碎石排出。其mPCNL組與改良通道PCNL組損傷胸腹膜者各有3例。術后發生尿路感染分別有28例和25例,經選用敏感抗生素治療3~5天體溫降至正常。結論:采用改良經皮腎通道治療復雜性上尿路結石能明顯縮短手術時間,提高結石取凈率并不增加出血、感染、胸腹腔損傷等并發癥。

Citation： HE Jun,SUN Xianyu,YU Zhou,et al.. Modified Percutaneous Nephrolithotomy for Treatment of Complexity Upper Urinary Calculus. West China Medical Journal, 2009, 24(9): 2306-2308. doi: Copy

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3.	DAVOL P E,WOOD C,FULMER B,et al.Success in treating renal calculi with singleaccess,singleevent percutaneous nephrolithotomy:is a routine “second look”necessay[J].J Endourol,2006,20(5):289-292.
4.	GUOHUA Z,ZHONG,W,LI X,et al.Minimally invasive percutaneous nephrolithotomy ror staghorn calculi:a novel single session approach via multipie 1418Fr tracts[J].Surg Laparosc Endosc percutan Tech,2007,17(2):124-128.
5.	李遜,吳開俊.多通道經皮腎穿刺取石治療復雜性腎石[J].中華泌尿外科雜志,1998,8:469-470.
6.	HEGARTY N J,DESAI M M.percutaneous nephrolithotomy requirring multiple tracts:comparison of morbidity with singletract procedures[J].J Endourol,2006,20(10):753-760.
7.	宋立新.經皮腎鏡取石術后發熱的臨床意義[J].國外醫學泌尿系統分冊,1999,19(4):192-193.

1. LAHMES, BICHLER K H, STROHMAIER W L,et al.Minimally invasive PCNL in patients with renal pelvic and calyceal stones[J].Eur Urol,2001,40(6):619-624.
2. 李遜.微創經皮腎穿刺取石術(mPCNL)[J].中國現代手術學雜志,2003,7:338—344.
3. DAVOL P E,WOOD C,FULMER B,et al.Success in treating renal calculi with singleaccess,singleevent percutaneous nephrolithotomy:is a routine “second look”necessay[J].J Endourol,2006,20(5):289-292.
4. GUOHUA Z,ZHONG,W,LI X,et al.Minimally invasive percutaneous nephrolithotomy ror staghorn calculi:a novel single session approach via multipie 1418Fr tracts[J].Surg Laparosc Endosc percutan Tech,2007,17(2):124-128.
5. 李遜,吳開俊.多通道經皮腎穿刺取石治療復雜性腎石[J].中華泌尿外科雜志,1998,8:469-470.
6. HEGARTY N J,DESAI M M.percutaneous nephrolithotomy requirring multiple tracts:comparison of morbidity with singletract procedures[J].J Endourol,2006,20(10):753-760.
7. 宋立新.經皮腎鏡取石術后發熱的臨床意義[J].國外醫學泌尿系統分冊,1999,19(4):192-193.

West China Medical Journal

Modified Percutaneous Nephrolithotomy for Treatment of Complexity Upper Urinary Calculus

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