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目的探讨斜卧位B超引导微通道经皮肾输尿管镜碎石术治疗复杂肾结石的方法、疗效及安全性。方法对26例接受斜卧位B超引导微通道经皮肾输尿管镜碎石术治疗的复杂性肾结石患者的临床资料进行回顾性分析。结果本组26例患者均成功行一期取石,单一通道24例,双通道2例,一期取净结石率65.4%(17/26),有残石者联合体外震波碎石术,三个月内结石总排净率80.7%(21/26)。手术时间55~180min,术中出血量30~250mL;肾造瘘管留置时间平均5.2d,术后平均住院8.3d,未出现严重的并发症。结论微通道经皮肾输尿管镜碎石术治疗复杂肾结石具有损伤小,恢复快,住院时间短,结石清除率高,并发症少等优点,是治疗复杂性肾结石较好的微创方法;采用改良斜卧位,患者体位耐受性好,可采用持续硬膜外麻醉,不影响手术治疗效果;B超引导下穿刺具有简便、安全、无放射性损伤等优点,更易在基层医院推广应用。
Objective To investigate the method, efficacy and safety of transrectal B-guided microchannel percutaneous nephrolithotomy in the treatment of complex renal calculi. Methods A retrospective analysis was performed on the clinical data of 26 patients with complicated renal calculi undergoing transrectal B-guided microchannel percutaneous nephrolithotomy. Results The group of 26 patients were successfully performed the first stage of stone, a single channel in 24 cases, two-channel in 2 cases, a net stone rate of 65.4% (17/26), residual stone combined with extracorporeal shock wave lithotripsy, three Month total stone clearance rate of 80.7% (21/26). The operation time was 55 ~ 180min and the intraoperative blood loss was 30 ~ 250mL. The average time of renal fistula indwelling was 5.2d and the average postoperative hospital stay was 8.3d. There was no serious complication. Conclusion Micro-channel percutaneous nephrolithotomy is a minimally invasive method to treat complicated nephrolithiasis with less injury, faster recovery, shorter hospital stay, higher stone clearance and fewer complications. Adoption of modified oblique position, patient position tolerance is good, continuous epidural anesthesia can be used, does not affect the surgical treatment effect; B-guided puncture with the advantages of simple, safe, non-radioactive injury, easier to promote the use of primary hospital.