超聲引導下微創經皮腎鏡治療復發性腎結石

[摘要] 目的 探討超聲引導下微創經皮腎鏡治療復發性腎結石的可行性和療效。方法 回顧性分析50例采用超聲波引導下MPCNL治療復發性腎結石的資料，病例當中全鹿角狀結石21例，部分鹿狀結石19例，多發性結石10例。結果 50例手術均成功，手術進行時間平均為120 min，43例一期MPCNL取凈結石（86%），5例進行二期MPCNL后，結石清除率達到96%，無術后出血，更無其余臟器損傷，其余經保守治療均成功治愈，治愈率達100%。結論 超聲引導下微創經皮腎鏡治療復發性腎結石創傷少，腎結石清除率高，恢復快，復發率低，可以作為治療復發性腎結石的首選方法。

[關鍵詞] 超聲波；經皮腎鏡；復發性腎結石

[中圖分類號] R693.4 [文獻標識碼] B [文章編號] 2095-0616（2013）13-205-02

Treatment of renal calculi with minimally invasive percutaneous nephrolithotomy under the guide of B ultrasound

LI Hongbo

The First Department of Surgery，Affiliated Lianjiang Hospital of Guangdong Medical College，Lianjiang 524400，China

[Abstract] Objective To evaluate the feasibility and efficacy of minim ally invasive percutaneous nephrolithotomy （MPCNL） under the guide of B ultrasound in treating renal calculi. Methods The data of 50 patients with renal calculi who had undergone MPCNL were retrospectively analyzed.Fifty patients with renal calculi（21 cases with complete staghorn calculi，19 cases with partial staghorn calculi and 10 cases with multiple renal calculi） were treated by MPCNL. Results All operations were successful and the mean operating time was 120 minutes.43 cases（86.0%） were rendered stone free after the first session，5 cases had a second- look MPCNL and the clearance reached 96.0%.No blood transfusion was needed after operation and even no viscera injuried. The rest of the patients were successfully cured with conservative treatment.The cure rate reached 100%. Conclusion Treatment of renal calculi with MPCNL under the guide of B ultrasound is an effective and feasible therapeutic option for patients with recidivity renal calculi，its advantages of less invasiveness and complications， higher clearance rate and shorter duration for hospitalization.Therefore it may be chosen as the first choice for treatment of patients with renal calculi.

[Key words] B ultrasound；Invasive percutaneous nephrolithotomy；Recidivity renal calculi

近年來，腎結石在我國的病例呈不斷上升的趨勢，治療腎結石尤其是治療復發性腎結石，采取何種治療方式，能做到創傷少，腎結石清除率高，恢復快，復發率低，成為國內醫院無可避免的難題。超聲定位由于安全、實時、準確越來越被臨床所采用[1]。2010年8月～2013年1月，我們用超聲引導下微創經皮腎鏡（MPCNL）治療復發性腎結石50例，療效十分理想。現報道如下。

1 資料與方法

1.1 一般資料

本組采用超聲引導下微創經皮腎鏡下進行MPCNL治療復發性腎結石50例，其中男35例，女15例，年齡18～75歲，平均年齡58歲。經CT和B超檢查顯示：左腎結石和右腎結石分別為15和21例，雙腎結石14例。直徑2.5 cm×1.0 cm ～ 3.0 cm×2.2 cm，病例當中全鹿角狀結石21例，部分鹿狀結石19例，多發性結石10例。本次病例入院輕度腎積水10例，中重度腎積水20例，并發腎功能不全6例。

1.2 治療方法