CAJ | 학술논문

目的评价经肾上盏入路行PCNL的疗效及安全性.方法 2007年10月至2009年10月行经肾上盏入路PCNL治疗肾结石患者42例.其中鹿角形结石10例,肾盂结石22例,肾上盏结石7例,下盏多发结石3例;合并输尿管上段结石4例,合并肾盂输尿管连接部狭窄(UPJO)2例;结石长径2.0～6.5 cm,平均3.4 cm.B超引导下选取肾上盏穿刺,穿刺点选在第10或11肋间,建立经皮肾通道(16～26 F).经皮肾镜或输尿管镜下气压弹道或钬激光碎石. 结果 42例均一期成功建立经皮肾通道并碎石.单通道取石36例(85.7%),双通道取石6例(14.3%).手术时间30～140 min,平均65 min.术后发热4例(9.5%),输血1例(2.4%),肾盂穿孔1例(2.4%).无气胸、血胸、腹腔脏器损伤.一期结石清除率88.1%(37/42),3例(7.1%)行二次肾镜取石,2例(4.8%)辅助体外冲击波碎石(ESWL)治疗. 结论经肾上盏入路PCNL活动范围大,对于部分复杂性肾结石碎石取石方便,是一种安全有效的方法.
목적 평개경신상잔입로행PCNL적료효급안전성.방법 2007년10월지2009년10월행경신상잔입로PCNL치료신결석환자42례.기중록각형결석10례,신우결석22례,신상잔결석7례,하잔다발결석3례;합병수뇨관상단결석4례,합병신우수뇨관련접부협착(UPJO)2례;결석장경2.0～6.5 cm,평균3.4 cm.B초인도하선취신상잔천자,천자점선재제10혹11륵간,건립경피신통도(16～26 F).경피신경혹수뇨관경하기압탄도혹화격광쇄석. 결과 42례균일기성공건립경피신통도병쇄석.단통도취석36례(85.7%),쌍통도취석6례(14.3%).수술시간30～140 min,평균65 min.술후발열4례(9.5%),수혈1례(2.4%),신우천공1례(2.4%).무기흉、혈흉、복강장기손상.일기결석청제솔88.1%(37/42),3례(7.1%)행이차신경취석,2례(4.8%)보조체외충격파쇄석(ESWL)치료. 결론경신상잔입로PCNL활동범위대,대우부분복잡성신결석쇄석취석방편,시일충안전유효적방법.
Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy (PCNL)guided by ultrasonography through upper pole access. Methods From October 2007 to October 2009, 42 patients with upper urinary tract calculi underwent PCNL through upper pole access.Among these cases, there were 10 cases of staghorn calculi, 22 cases of renal pelvis calculi, 7 cases of the upper calyx calculi, 3 cases of the lower calyx calculi, 4 cases combined with ureter calculi and 2 cases combined with ureteropelvic junction obstruction. The stone measured from 2.0 to 6.5 cm (average: 3.4 cm) in length. Working tunnels (F16-F26) were established through the 10th or llth intercostals. Pneumatic or holmium laser lithotripsy was used to disintegrate and remove stones by nephroscopy or ureteroscopy. Clinical data including operation time, complications and stone free rate were analyzed retrospectively. Results All the operations were completed in one session, single tract was used in 36 cases(85.7%), double tracts were used in the other 6 cases(14.3%). The stonefree rate after one session was 88.1% (37/42), 3 cases(7.1%) received a second-session PCNL, 2 cases (4.8%)underwent ESWL after operation. The mean operative time was 65 min(30- 140 min).Postoperative surgery-related infection rate was 9. 5% (4/42). One patient (2. 4%)required blood transfusion. Perforation of the pelvis occurred in 1 patient(2.4 %). No pleural or important organ injury occurred. Conclusion The upper pole access for PCNL can be convenient to remove stones,this method is a highly efficient and safe technique.