经皮肾镜术治疗开放手术后肾结石56例报道

论著经皮肾镜术治疗开放手术后肾结石56例报道

鄢世兵，何昌孝，袁正勇，黄颖川，王翰辉，李冬

（都江堰市医疗中心泌尿外科，四川都江堰611830）

【摘要】目的探讨经皮肾镜术治疗开放手术后肾结石的安全性和临床疗效。方法本组共56例患者，既往均曾

行上尿路开放手术，包括肾盂和/或肾实质切开取石38例，肾盂离断成形术6例，输尿管上段切开取石术12例。左侧24

例、右侧32例。结石单发12例、多发27例、鹿角状结石及多发结石17例。结石大小0.8cmˑ0.6cm 8.7cmˑ5.5cm。所

有患者均采用B超引导下穿刺，逐级扩张建立经皮肾通道，结石负荷小的患者采用F20通道，结石负荷大的患者采用F24

标准通道，气压弹道及超声负压粉碎并清除结石。结果56例均顺利建立经皮肾造瘘通道，并行一期碎石术，51例单通道，5例双通道;穿刺通道在十一肋间37例，十二肋下19例;碎石手术时间15 180min，平均54min;术中出血量20 1000ml，平均150ml，2例输血;9例残石平均0.6 1.2cm，结石清除率84%(47/56)。术中无气胸或邻近脏器损伤等严重

并发症，2例术后明显出血，经高选择性动脉栓塞后止血。8例肾功不全者，3例肾功恢复正常，5例维持在低氮质血症水平。结论经皮肾镜术治疗上尿路开放手术后肾结石安全有效。

【关键词】肾结石;开放手术后;经皮肾镜取石术

【中图分类号】R692.4【文献标识码】A【文章编号】1004-0501(2012)12-2129-03

Percutaneous nephrolithotomy in patients with previous open surgery of kidney and upper ureter（A report of56ca-ses）．YAN Shi-bing，HE Chang-xiao，YUAN Zheng-yong，et al．Dujiangyan Medical Center，Dujiangyan，Sichuan，611830，Chi-

na

【Abstract】Objective To evaluate the safety and efficacy of percutaneous nephrolithotomyfor renal calculi in patients with previous open surgery of kidney and upper ureter．Methods56patients with previous open surgery of kidney and upper ureter were retrospectively investigated by percutaneous nephrolithotomy．Of all56cases，38patients had open pyelolithotomy and/or nephrolithotomy，6had pyeloplasty，12had open ureterolithotomy．24calculi were in left kidney and32in right side．2cases had single calculus，27had multiple，and17had staghorn calculi with multiple stones．The stone burdons were0.8cmˑ0.6cm 8.7cm

ˑ5.5cm．All patients were underwent percutaneous nephrolithotomy with B type ultrasound guidance and different access by pneu-matic and ultrasonic power．Results The percutaneous renal accesses were successfully established in all56cases under ultra-sound guidance and immediate phase I lithotripsy were performed in all cases with single access for51cases and double accesses

for5case．The operation time were15 180mins with average time54mins．The blood loss were20 1000ml with averge150ml，and blood transfusion for2cases．Total stone free rate was84%．Residual stone fragments were found in9cases by postoperative KUB．No severe complications occurred except two patients received selective renal artery embolism for bleeding after PCNL．Of8 cases with renal function insufficiency，3cases have got normal renal function，while other5cases suffered from lower azotemia．Conclusion It’s safe and effective with little compilcations for patients with previous open surgery to treat renal calculi by percu-taneous nephrolithotomy with different access and pneumatic-ultrasonic power．

【Key words】renal calculi；previous open surgery；percutaneousnephrolithotomy（PCNL）

肾脏及上段输尿管开放手术后肾周组织粘连形成瘢痕，且肾脏和周围脏器的相对关系发生了变化；同时原来的积水肾由于梗阻解除后肾脏会不同程度缩小。已行开放手术的肾脏如果形成肾结石需要再次开放手术取石，由于上述原因使手术难度加大甚至成为开放手术禁忌，而体外冲击波碎石或经皮肾镜取石术可能是惟一选择。2008年5月 2012年3月，我们采用B 超引导下经皮肾穿刺造瘘不同通道下气压弹道碎石及联合应用超声碎石取石治疗上尿路结石317例（共342侧），其中有上尿路开放手术史的肾结石56例，取得较满意的效果，现报告如下。

1资料与方法

1.1一般资料：本组共56例患者，男33例，女23例；