CAJ | 학술논문

目的探讨B超引导下PCNL治疗上尿路结石的有效性与安全性. 方法 2004年6月至2009年7月行超声引导下PCNL 1289例.其中输尿管上段结石386例;肾单发结石463例,多发结石355例,鹿角形结石85例.结石大小0.8 cm×1.2 cm～9.0 cm×5.3 cm,平均2.1 cm×3.1 cm.伴不同程度肾积水935例. 结果 1289例无中转开放及死亡.平均手术时间90(55～220)min,平均术中出血量175(60～800)ml.术中、术后输血31例,术后因出血行超选择性肾动脉栓塞术14例(1.09%).一期单通道取石1105例,二通道取石108例,三通道取石76例.一期结石取净率85.03%(1096/1289);193例结石残留者中,67例行ESWL,126例行二期PCNL,其中85例结石取净.总结石取净率91.62%(1181/1289).结论 B超引导下PCNL治疗上尿路结石具有定位准确、工作通道建立安全简便、结石取净率高、创伤小、并发症少等特点,手术适应证选择、手术技巧掌握、相应配套设施的保障是PCNL成功的关键.
목적 탐토B초인도하PCNL치료상뇨로결석적유효성여안전성. 방법 2004년6월지2009년7월행초성인도하PCNL 1289례.기중수뇨관상단결석386례;신단발결석463례,다발결석355례,록각형결석85례.결석대소0.8 cm×1.2 cm～9.0 cm×5.3 cm,평균2.1 cm×3.1 cm.반불동정도신적수935례. 결과 1289례무중전개방급사망.평균수술시간90(55～220)min,평균술중출혈량175(60～800)ml.술중、술후수혈31례,술후인출혈행초선택성신동맥전새술14례(1.09%).일기단통도취석1105례,이통도취석108례,삼통도취석76례.일기결석취정솔85.03%(1096/1289);193례결석잔류자중,67례행ESWL,126례행이기PCNL,기중85례결석취정.총결석취정솔91.62%(1181/1289).결론 B초인도하PCNL치료상뇨로결석구유정위준학、공작통도건립안전간편、결석취정솔고、창상소、병발증소등특점,수술괄응증선택、수술기교장악、상응배투설시적보장시PCNL성공적관건.
Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL) under ultrasonic guidance for the treatment of upper urinary calculus. Methods From June 2004 to July 2009, 1289 patients with upper urinary tract calculi were treated with PCNL under ultrasonic guidance, 386 cases of them were upper ureteral calculi, 463 cases were single renal calculi,355 cases were multiple renal caculi, 85 cases were staghorn calculi. Calculus size was 0.8 cm× 1.2cm-9.0 cm× 5.3 cm,mean 2. 1 cm× 3.1 cm. Nine hunderd and thirty-five cases were with hydronephrosis. Results All patients were performed PCNL successfully, without conversion to open surgery or death. Mean operation time was 90(55-220)min, mean operative blood loss was 175(60-800)ml. Thirty-one cases were given blood transfusion during operation or post operation, 14 cases were given super-selective renal artery embolism for bleeding control. 1105 cases were treated with single tract, 108 cases with double tracts, 76 cases with three tracts. Calculus clearance rate of onestage PCNL was 85.03%(1096/1289);193 cases were found with residual calculi, 67 of them were given extracorporeal shock-wave lithotripsy, 126 of them were given two-stage PCNL, calculi were removed complelety in 85 cases. Total calculus clearance rate was 91.62%(1181/1289). Conclusions PCNL under ultrasonic guidance is an effective and safe method for the treatment of upper urinary calculus with advantages of accurate positioning, high calculus clearance rate, minimal trauma, and fewer complications. The key of successful PCNL is selection of patients, grasp of operation technique, and availability of other equipements.