留置输尿管外支架的无管化经皮肾镜取石术的安全性和效果分析

刘永达，袁坚，曾国华等.留置输尿管外支架的无管化经皮肾镜取石术的安全性和效果分析[J].临床泌尿外科杂志.2013,28(4):295-297.

目的:探讨留置输尿管外支架的无管化经皮肾镜取石术(tubeless percutaneous nephrolithotomy,tubeless PCNL)的安全性和有效性。方法:回顾性分析43例留置输尿管外支架的tubeless PCNL治疗肾或输尿管上段结石的患者资料。男23例,女20例,平均年龄44.9岁。其中肾盂结石22例,输尿管上段结石18例,肾多发性结石3例。结石最大径为(2.4±1.1)cm。合并患肾轻度积液4例,中度积液21例,重度积液18例。在经皮肾镜取石术结束时,通过B超和C臂X线证实结

刘永达，袁坚，曾国华，雷鸣，罗金泰，张泽，钟惟德

南方医科大学； 广州医学院第一附属医院微创外科中心泌尿外科；

2013

295-297

知网

目的:探讨留置输尿管外支架的无管化经皮肾镜取石术(tubeless percutaneous nephrolithotomy,tubeless PCNL)的安全性和有效性。方法:回顾性分析43例留置输尿管外支架的tubeless PCNL治疗肾或输尿管上段结石的患者资料。男23例,女20例,平均年龄44.9岁。其中肾盂结石22例,输尿管上段结石18例,肾多发性结石3例。结石最大径为(2.4±1.1)cm。合并患肾轻度积液4例,中度积液21例,重度积液18例。在经皮肾镜取石术结束时,通过B超和C臂X线证实结石已经完全清除,然后把逆行插入的输尿管导管的头端调整至肾盂的中央,让扩张鞘退至肾造瘘通道以外,证实瘘道无活动性出血,最后拔除扩张鞘,并用丝线缝合皮肤伤口。结果:43例患者,其中41例结石完全清除,2例为无意义残留结石。手术时间30～75min,平均45min。手术引起血红蛋白平均下降6.5g/L。术后第1天视觉疼痛评分为(3.0±1.4)分。术后平均住院天数为3d。术后出现急迫性尿失禁1例,肾周血肿1例,发热2例,持续性肉眼血尿2例,轻度尿外渗2例。结论:在严格掌握手术适应证的前提下,留置输尿管外支架的tubeless PCNL是安全和有效的。 Objective: To review the safety and efficacy of tubeless percutaneous nephrolithotomy Ctubeless per cutaneous nephrolithotomy, PCNL) with a ureteral catheter. Vletboc3:From 1Way 2010 to Dec 2011，43 cases C23 males and 20 femals, mean age of 44. 9 years) of renal or proximal ureteral calculi treated by tubeless PCNI_ with a ureteral catheter were reviewed. There were 22 cases with renal pelvic calculi, 18 cases with upper ureteral cal- cu1i, 3 cases with multiple renal calculi. The stone burden was (2. 4-1. 1) cm. Of 43 cases.mild hydronephrosis was found in 3 cases.moderate hydronephrosis in 21 cases·and severe hydronephrosis in 18 cases. At the end of the procedure of PCNI，the calculi were cleared under the monitoring of C-armed fluoroscopy and B-ultrasound. The head end of the ureteral catheter was adjusted in the center of renal pelvis. The peel-away sheath was removed when no active bleeding was confirmed. Result: Of 43 cases.stone-free was found in 41 cases, and insignificant re- sidual stone in 2 cases. The average operative time was 45 (30-75)min. The mean hemoglobin drop was 6. 5 C3- 10) g/I_. The visual analogue score on the first postoperative day was(3. 0士1. 4).The average postoperative hospital stay was 3 days. The complications included one urge incontinence, one perirenal hematoma, one postop- erative fever, two persistent macrohematuria, and two mild urinary extravasation. Conclusion; Under the premise of strict surgical indications, tubeless P(一NL with a ureteral catheter was safe and effective for the treatment of up- per urinary calculi.