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目的探讨微造瘘经皮肾输尿管镜取石术(MPCNL)治疗上尿路结石的疗效。方法从2007年5月～2012年5月应用MPCNL治疗上尿路结石患者187例,首先造成患侧肾脏的人工肾积水,建立经皮肾通道(F16～18),全部建立单通道取石187例,在输尿管镜下使用钬激光碎石。结果 187例中有183例行I期取石。4例行Ⅱ期取石。术中、术后有明显出血7例,约占4%,1例术后不可控制出血行介入治疗成功,余均经对症治疗出血停止。2例术后出现尿外渗,经调整肾造瘘管位置后治愈。平均结石清除率为90.32%,平均手术时间69分钟,估计术中平均出血量约80mL,术后平均住院10天,肾造瘘管平均留置时间7.5天。结论 MPCNL治疗上尿路结石安全、有效,对患者创伤小、恢复快、结石清除率高,疗效满意。
Objective To investigate the effect of percutaneous nephroureteroscopic lithotripsy (MPCNL) in the treatment of upper urinary tract calculi. Methods From May 2007 to May 2012, 187 patients with upper urinary tract calculi were treated with MPCNL. First of all, artificial kidney hydronephrosis of the ipsilateral kidney was established. Percutaneous renal access (F16 ~ 18) was established and all the single access 187 For example, holmium laser lithotripsy is used under ureteroscopy. Results 187 cases of 183 cases of I line stone. 4 routine Ⅱ stone. Intraoperative and postoperative significant hemorrhage in 7 cases, accounting for about 4%, 1 case of uncontrollable hemorrhage after interventional treatment was successful, Yu were stopped by the symptomatic treatment of bleeding. 2 cases of postoperative urinary extravasation, adjusted by the location of renal fistula cured. The average stone clearance rate was 90.32%, the average operation time was 69 minutes. The average intraoperative blood loss was estimated to be about 80mL. The average postoperative hospital stay was 10 days. The average length of nephrostomy was 7.5 days. Conclusion MPCNL treatment of upper urinary tract stones safe and effective, small trauma patients, rapid recovery, high rate of stone clearance, the effect is satisfactory.