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目的探讨微创经皮肾通道输尿管硬镜下取石术(MPCNL)治疗孤立肾肾结石的临床疗效与手术技巧。方法利用MPCNL技术治疗孤立肾肾结石22例,其中9例先行经皮肾穿刺造瘘术,7～10d后行二期经皮肾镜气压弹道碎石、取石术,其余13例患者均行一期经皮肾镜气压弹道碎石、取石术。18例采用单通道取石,4例采用2通道取石。结果结石清除17例(77.27%)。在结石残留的5例患者中,2例残留结石移行至输尿管上段给予ESWL治疗,结石顺利排出;1例残留结石下移至输尿管下段,用输尿管镜将结石取出;余2例结石残留肾内,未作进一步处理,定期观察。本组患者术后肾功能基本恢复正常或明显好转,手术效果良好,除1例孤立肾结石合并尿路感染,一期取石术后出现中毒性休克,其余患者术后未出现严重的并发症。结论MPCNL疗效肯定,具有安全、实用、损伤小、并发症少,恢复快等优点。MPCNL在处理孤立肾结石并发梗阻性肾衰中,可作为首选治疗方法。
Objective To investigate the clinical effects and surgical techniques of minimally invasive percutaneous renal access ureteral calculi (MPCNL) in the treatment of solitary kidney stone. Methods Twenty-two cases of isolated kidney and kidney stones were treated with MPCNL technique. Nine cases underwent percutaneous nephrostomy, two stage percutaneous nephrolithotracheal lithotripsy and lithotripsy after 7-10 days, and the other 13 cases underwent one Percutaneous nephroscopic pneumatic lithotripsy, lithotomy. 18 cases of single-channel stone, 4 cases of 2-channel stone. Results of stone removal in 17 cases (77.27%). Among the 5 patients with residual stones, 2 cases of residual stones migrated to the upper ureter to give ESWL treatment, stones were discharged smoothly; 1 case of residual stones was moved to the lower ureter with ureteroscope to remove stones; the remaining 2 cases of residual stone, No further processing, regular observation. The patients with postoperative renal function returned to normal or significantly improved, the effect is good, in addition to a case of isolated nephrolithiasis with urinary tract infection, a staging after a toxic shock, the rest of the patients did not appear after serious complications. Conclusions MPCNL is effective, safe, practical, less injury, less complications, faster recovery and so on. MPCNL in the treatment of isolated renal stones complicated by obstructive renal failure, can be used as the preferred method of treatment.