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目的:探讨和总结上尿路结石微创综合治疗的有效方法和经验。方法:采用经皮肾微造瘘输尿管镜取石术(MPCNL)、逆行输尿管镜碎石术(URL)、体外冲击波碎石术(ESWL)等方法治疗复杂性上尿路结石患者52例,其中采用MPCNL治疗52例,俯卧位44例,侧卧位8例;采用URL治疗31例;采用ESWL治疗16例。最大结石直径1.7～4.0 cm,平均(2.40±0.07)cm。结果:52例患者住院天数9～22天,平均(15.27±0.46)天。Ⅰ期结石清除率71.1%(37/52),Ⅱ期结石清除率60.0%(9/15),总的结石清除率88.5%(46/52);Ⅰ期结石清除率与总的结石清除率比较,差异有统计学意义(P<0.05)。其中15例肾功能不全患者术前肌酐平均值为(326.87±63.28)mmol/L,术后1～3个月拔管后血肌酐平均值为(142.60±28.53)mmol/L,二者比较差异有统计学意义(P<0.05)。术中无气胸、腹腔脏器损伤等并发症发生。最后6例有残余结石,术中大出血3例(5.7%),肾对穿(孔)2例,输尿管穿孔2例(7.7%),尿外渗5例(9.6%),术后休克1例(1.9%),发热9例(17.3%)。结论:在治疗复杂性上尿路结石患者的过程中,制定个体化微创综合治疗方法非常重要,可以明显提高结石清除率,有效保护和改善肾功能,减少机体损伤以及其他并发症发生。
Objective: To explore and summarize the effective methods and experience of minimally invasive treatment of upper urinary tract stones. Methods: 52 cases of complex upper urinary tract calculi were treated with percutaneous nephrostomy ureteroscopic lithotripsy (MPCNL), retrograde ureteroscopic lithotripsy (URL) and extracorporeal shock wave lithotripsy (ESWL) 52 cases were treated with MPCNL, 44 cases were prone position and 8 were lateral position. Thirty-one cases were treated with URL and 16 cases were treated with ESWL. The largest diameter of stones 1.7 ~ 4.0 cm, with an average (2.40 ± 0.07) cm. Results: 52 patients hospitalized for 9 to 22 days, with an average of (15.27 ± 0.46) days. The stone clearance rate of stage Ⅰ was 71.1% (37/52), the stone clearance rate of stage Ⅱ was 60.0% (9/15) and the total stone clearance rate was 88.5% (46/52). The rate of stage Ⅰ stone clearance and total stone clearance The difference was statistically significant (P <0.05). The average creatinine before operation was (326.87 ± 63.28) mmol / L in 15 patients with renal insufficiency, and the average value of serum creatinine after extubation was (142.60 ± 28.53) mmol / L 1-3 months after operation There was statistical significance (P <0.05). No pneumothorax, abdominal organ injury and other complications occurred. The last 6 cases had residual stones, 3 cases (5.7%) of intraoperative hemorrhage, 2 cases of perforation (2 holes), 2 cases of ureter perforation (7.7%), 5 cases of exudation of urine (9.6%) and 1 case of postoperative shock (1.9%), fever in 9 cases (17.3%). Conclusion: It is very important to develop a personalized minimally invasive comprehensive treatment in the treatment of patients with complicated upper urinary tract calculi. It can significantly improve the stone clearance rate, effectively protect and improve renal function, reduce the body injury and other complications.