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目的:分析微创经皮肾镜碎石术(minimal invasive percutaneous nephrolithotomy,mPCNL)治疗输尿管上段嵌顿性结石的临床疗效。方法:采用B超或X线定位,mPCNL治疗102例嵌顿性输尿管上段结石,其中2例经皮穿刺抽吸脓性尿液,留置造瘘管,抗炎治疗后二期手术。术后生命体征、B超和尿路平片(kindeyureterbladder,KUB)等检查并随访。结果:100例Ⅰ期穿刺成功并气压弹道或钬激光mPCNL,手术时间55-75min。碎石、取石时间15-35min。术后住院4-7d。无穿刺损伤腹腔脏器、术中未有肾盂穿孔和输尿管损伤、无大出血等术中和术后并发症。mPCNL术后2dKUB检查结石清除率为91.1%(93/102),9例残留结石,术后辅以体外冲击波碎石治疗。术后1个月结石清除率为100%(102/102)。结论:微创经皮肾穿刺取石治疗嵌顿性输尿管上段结石创伤小、恢复快且有很高的清除率,值得临床推广应用。
Objective: To analyze the clinical efficacy of minimal invasive percutaneous nephrolithotomy (mPCNL) in the treatment of incarcerated upper ureteral calculi. Methods: One hundred and two cases of incarcerated upper ureteral calculi were treated with m- or b-type ultrasonography and mPCNL. Among them, 2 cases were percutaneously aspirated purulent urine, indwelling fistula and anti-inflammatory treatment. Postoperative vital signs, B-ultrasound and urinary tract plain film (KUB) were examined and followed up. Results: 100 cases of stage Ⅰ puncture and pneumatic orbital or holmium laser mPCNL, operation time 55-75min. Gravel, stone time 15-35min. Postoperative hospital 4-7d. No puncture injury abdominal organs, intraoperative peritoneal perforation and ureteral injury, no bleeding and other intraoperative and postoperative complications. The clearance rate of KUB stones was 91.1% (93/102) in 2 days after mPCNL. Nine residual stones were treated with extracorporeal shock wave lithotripsy. The stone clearance rate was 100% (102/102) at 1 month after operation. Conclusion: Minimally invasive percutaneous nephrolithotomy for the treatment of incarcerated upper ureteral calculi trauma, rapid recovery and a high clearance rate, worthy of clinical application.