局麻上盏入路经皮肾碎石术治疗复杂性肾结石 附581 例报告.pdfVIP

2011;31(12) 南方医科大学学报（J South Med Univ ） ·2079 · ·临床研究· 局麻上盏入路经皮肾碎石术治疗复杂性肾结石：附581例报告 李虎林，刘春晓，徐啊白，许 凯，陈玢屾，郭 凯，林阳彦，朱瑞龙 南方医科大学珠江医院泌尿外科，广东 广州 510282 摘要：目的探讨经皮肾碎石治疗复杂性肾结石的最佳路径。方法局麻下经上盏入路建立经皮肾通道治疗复杂性肾结石 581例。其中上盏多发结石55例，铸型结石136例，部分铸型结石145例，肾多发结石245 例。结果581例患者均穿刺成功 并行碎石术，单通道结石完全清除率90.3%(525/581) ，其中有35 例患者需二通道碎石，10例三通道，2 例4 通道，1例5通道 碎石，总结石完全清除率94.6%(550/581)。手术时间10~ 130 min（平均45 min）。术中穿刺成功率100% ，无胸膜、肠管、腹 膜和周围脏器损伤等严重并发症。结论经上盏入路的经皮肾碎石术能沿着肾脏的纵轴往下，较顺利的进入肾的收集系 统和输尿管上段，有较高的结石清除率，是治疗复杂性肾结石比较理想的入路。 关键词：局麻；上盏；经皮肾；复杂性肾结石 中图分类号：R69 文献标志码：A 文章编号：1673-4254（2011）12-2079-03 Percutaneous nephrolithotomy through the upper pole calix access for complicated renal calculi: report of 581 cases LI Hu-lin, LIU Chun-xiao, XU A-bai, XU Kai, Chen Bin-shen, GUO Kai, LIN Yang-yan, ZHU Rui-long Department of Urology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China Abstract: Objective To discuss the optimal approach of percutaneous nephrolithotomy (PCNL) for treatment of complicated renal calculi. Methods A total of 581 patients with complicated renal calculus were treated by PCNL through the upper pole calix access. Of the 581 patients, 55 had multiple upper pole calculi, 136 had staghorn stones, 145 had partial staghorn stones, and 245 had multiple renal calculi. Results PCNL through the upper pole calix access was completed successfully in all the cases. Of these patients, 90.3% (525/581) were stone-free after a single access, with a total stone-free rate of 94.6% (550/581). Thirty-five patients needed two accesses, 10 needed 3 accesses, 2 required 4 accesses, and 1 patients had 5 accesses. The operative time ranged from 30 to 150 min (mean 45 min). The successfu