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目的总结平卧位微穿刺造瘘经皮肾镜碎石取石术的临床经验。方法56例结石患者,结石位于左肾23例、右肾26例、输尿管上段7例。结石大小平均为2．6 cm×1．7 cm,单发结石17例,多发复杂性肾结石26例,肾铸形或鹿角形结石13例,最大铸形结石为5．7 cm×7．2 cm×4．3 cm。伴重度肾积水者9例,轻中度肾积水者29例。患者取平卧位,患侧腰胁部垫高,B超引导下进行穿刺、扩张建立经皮肾微穿刺通道,采用输尿管镜行经皮肾镜碎石取石术。结果56例碎石取石术均成功。1例术中输血200 ml,余55例均未输血。无一例出现严重并发症。一期结石取净40例(71．4％),残留结石16例,其中9例二期手术取净,3例行体外冲击波碎石术治愈,4例未进一步处理。结论平卧位行经皮肾镜碎石取石术患者体位舒适,击碎的结石更易冲出,而且利于麻醉师观察患者,方便气管插管等抢救措施的实施。
Objective To summarize the clinical experience of percutaneous nephrolithotomy in supine micro-puncture ostomy. Methods 56 cases of stone patients, stones in the left kidney in 23 cases, 26 cases of right kidney, ureter in 7 cases. The average size of stones was 2.6 cm × 1.7 cm. There were 17 cases of solitary stones, 26 cases of complex renal calculi, 13 cases of renal cast or antler stone, and the largest cast stone was 5.7 cm × 7. 2 cm × 4.3 cm. 9 cases with severe hydronephrosis, mild to moderate hydronephrosis in 29 cases. Patient supine position, ipsilateral lumbar lordosis, B-guided puncture, expansion of the establishment of percutaneous renal micro-puncture channel, the use of ureteroscopic percutaneous nephrolithotomy lithotripsy. Results 56 cases of lithotripsy were successful. One case of intraoperative blood transfusion 200 ml, more than 55 cases were not transfused. No case of serious complications. The first stage stones were removed in 40 cases (71.4%), residual stones in 16 cases, of which 9 cases were taken by the second phase of surgery, 3 cases were treated by extracorporeal shock wave lithotripsy, 4 cases without further treatment. Conclusion Percutaneous nephrolithotomy lithotripsy patients with comfortable position, crushed stones more easily washed out, but also conducive to the anesthesiologist to observe the patient, to facilitate the implementation of tracheal intubation and other rescue measures.