摘要
目的探讨上尿路结石的5种分型指征和用微创经皮肾输尿管肾镜取石术MPCNL治疗的价值。方法回顾分析2005年至2009年行MPCNL术的423例上尿路结石病例。男220例,女203例,年龄18～83岁,平均43岁。根据上尿路的解剖特点,结石的位置大小和形状、肾盂肾盏积水程度、造瘘通道数目等影响MPCNL手术难易的主要因素,将本组结石分为5种类型:Ⅰ型159例,Ⅱ型149例,Ⅲ型45例,Ⅳ型65例,Ⅴ型5例。结果MPCNL手术成功408例,失败15例。术后动静脉瘘出血7例,Ⅰ期324例,Ⅱ期81例,Ⅲ期3例;单通道352例,双通道48例,三通道8例。术后配合体外冲击波碎石(ESWL)52例,残石(大于0.5cm)57例。平均住院9.2d。无肾切除、死亡等。结论按结石分型选择合适病例开展MPCNL术,能提高手术成功率,缩短学习曲线,对早中期开展MPCNL的医师有较好的借鉴价值。
Objective To investigate the clinical value of 5 types upper urinary stones with minimally invasive pereutaneous nephrolithotomy （mPCNL）. Methods The data of 423 upper urinary stones patients （male： 220, female： 203） who underwent mPCNL during January 2005 to May 2009 were analyzed retrospectively. The average age were 43（18-83）. Based on the major factors that effects mPCNL procedure, such as anatomical characteristics of urinary tract, stone location, size and shape, degree of hydronephrosis, number of puncture access, the patients were divided into 5 types, typeⅠ：159 eases, type Ⅱ：149 cases, type Ⅲ： 45 cases, type Ⅳ：65 cases, type Ⅴ：5 cases. Results 408 cases were successfully treated by mPCNL, 15 cases were failed, and 5 cases were converted to open surgery. 7 patients were hemorrhage because of arteriovenous fistula. In these cases, 324 were treated in one-stage, 81 in two-stage, and 3 in 3-stage. 356 were performed by singer port,41 by dual-port, and 11 by tri-port. After mPCNL, 52 were combined with ESWL. 57 had remains stones, which of the diameter were bigger than 0.5 cm. The average time stay in hospital was 9.2 days. Conclusion According to difference of stone size, shape, location, degrees of obstruction, thickness of renal parenchyma and number of puncture access, upper urinary stone were divided into 5 types, just to summarize typing indication, key point and attention of MPCNL in each type. Because it is vary of treating upper urinary stones patients with mPCNL, selecting the appropriate method based on surgery types will be a good way to carry out the operation and increase the success rate gradually, reduce complications and learning curve, it is learning valuable for the surgery.
出处
《中华腔镜泌尿外科杂志（电子版）》
2010年第2期4-7,共4页
Chinese Journal of Endourology(Electronic Edition)
基金
福建省泉州市重点科研资助项目(2007Z1)
关键词
结石分型
通道
经皮肾碎石取石术
Surgery type
Puncture port
Percutaneous nephroscope
