摘要
目的探讨经皮肾取石术(percutaneous nephrolithotomy,PCNL)治疗老年肾结石的疗效及安全性。方法2005年1月～2011年12月对57例老年(年龄61～87岁,平均69岁)肾结石行PCNL。采用B超引导下建立经皮肾通道F16～F24,留置相应工作外鞘置入F8.0/9.8输尿管镜或F20.8经皮肾镜,钬激光或EMS碎石清系统碎石并清除结石。结果手术时间30～140 min,平均65 min。一期结石清除率78.9%(45/57)。1例术后体温>38.5℃,经抗感染治疗后好转;2例术中、术后出血较多(分别出血1800、2500 ml)给予输血治疗,其中1例因假性动脉瘤行肾动脉高选择性栓塞治疗好转。无一例损伤肝、脾等重要脏器及诱发呼吸和循环功能衰竭等其他严重并发症。12例结石残留者行二次PCNL 4例及辅助ESWL 5例,术后分别各有1例肾下盏少量结石残留,另7例无结石残留;5例结石残留随访6～24个月,除1例肾结石略有增大外其余4例无明显变化。46例结石清除者随访3～34个月,平均14.3月,除2例复发保守治疗外其余无复发。结论 PCNL治疗老年肾结石安全,疗效满意。积极的术前准备、熟练的经皮肾镜技术及加强围手术期监测和管理是提高安全性的关键。
Objective To explore the safety and efficacy of percutaneous nephrolithotomy （PCNL） for the treatment of renal calculi in elderly patients. Methods Totally 57 elderly patients （ mean age 69 years, ranged from 61 to 87 years） with renal calculi were treated by PCNL in our hospital from January 2005 to December 2011. Working tunnels F16 - F24 were established under B-ultrasound guidance. EMS or holmium laser lithotripsy was used to fragment and remove stones by nephroscopy. Results The procedure was completed in a mean of 65 min （ranged from 30 to 140 min） , and one-session stone-free rate was 78.9% （45/57）. After the procedure, one patient developed fever （ 〉 38. 5 ℃ ） and then was cured by antibiotics; two patients received blood transfusion （1800 and 2500 ml, respectively） because of massive hemorrhage, and one of them was diagnosed with pseudoaneurysm, and then was cured by selective renal artery embolization. No patient had severe complications. Residual stones were detected in 12 patients, 4 of them received a second PCNL, and 5 of them underwent postoperative ESML; one who received second PCNL and one who received ESML still showed a few residual stones in the lower renal calyces, the other 7 showed no residual stones after the second operation. Five of the 12 cases of residual stones were followed up for 6 to 24 months, 4 of them showed no significant change, and the other showed mildly enlarged renal stone. In the 46 patients who had the stones removed completely, follow-up was achieved for 3 to 34 months with a mean of 14.3 months, only 2 of them had recurrence and thus received conservative therapy. Conclusions PCNL is safe and effective for elderly patients with renal stones. The keys of the therapy include adequate preoperative preparation, skilled operation, and perioperative management.
出处
《中国微创外科杂志》
CSCD
2012年第11期1023-1025,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
经皮肾取石术
肾结石
老年患者
Percutaneous nephrolithotomy （PCNL）
Renal stones
Elderly patients
