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目的 探讨术前X线摄片和B超定位引导建立经皮肾穿刺通道 ,行微创经皮肾输尿管镜取石术 (MPCNL)治疗肾结石和输尿管上段结石的手术方法和临床价值。方法 术前将病人模拟手术体位 ,作X线下结石摄片定位与B超下肾穿刺点、穿刺方向及深度定位 ,建立经皮肾穿刺通道 ,对 15 8例肾结石、输尿管上段结石病人行微创经皮肾穿刺输尿管镜取石术治疗。结果 15 8例结石病人中 15 3例手术成功 ,5例失败 ,无一例中转开放性手术。 12 0例肾结石总取净率 88 33% ,肾盂梗阻解除率 10 0 %。 4 9例输尿管上段结石 (包括合并肾结石 11例 )均一次取净结石 ,总取净率 10 0 %。结论 术前B超和X线摄片定位引导建立经皮肾穿刺通道行微创经皮肾输尿管镜取石术可减少病人和术者的射线接受量 ,技术可行。
Objective To investigate the surgical methods and clinical value of preoperative radiography and translocation of B-guided percutaneous nephrostomy for minimally invasive percutaneous nephrolithotomy (MPCNL) in the treatment of renal calculi and upper ureteral calculi. Methods Fifteen patients with renal calculi and upper ureteral calculi were preoperatively treated with simulated body position, radiographs of calculi under X-ray and puncture point of B-ultrasonography, and the direction and depth of puncture. Minimally invasive percutaneous nephrolithotomy ureteroscopic lithotripsy. Results 15 3 of 15 8 cases of stone patients were operated successfully, 5 cases failed and none of them were transferred to open surgery. The total removal rate of renal calculi in 88 cases was 88.33%, the resolution of renal pelvis obstruction was 100%. 49 cases of upper ureteral calculi (including 11 cases of renal calculi) were taken net stones, the total net acquisition rate of 10%. Conclusions The preoperative B-mode ultrasonography and radiography to guide the establishment of percutaneous nephrostomy with minimally invasive percutaneous nephroureteroscopic lithotripsy can reduce the amount of radiation received by patients and surgeons, which is technically feasible.