Long Qilai, Guo Jianming, Xu Zhibing, Yang Yuanfeng, Wang Hang, Zhu Yanjun, Zhang Yongkang, Wang Guomin
Department of Urology, Zhongshan Hospital, Fudan University, Shanghai, China.
Urol Int. 2013;90(4):384-8. doi: 10.1159/000343668. Epub 2013 Apr 30.
To evaluate the efficacy and safety of mini- percutaneous nephrolithotomy (PCNL) in the treatment of large impacted proximal ureteral stones.
We retrospectively reviewed the outcomes of 163 patients who underwent mini-PCNL between January 2006 and August 2010. Mean age was 48.6 years and mean stone size was 18.4 mm. Hydronephrosis and/or hydroureterosis appeared in all patients. In the prone position, percutaneous access (16-Fr sheath) was established by placement of an access needle into the intended calyx under fluoroscopic guidance or combined with ultrasound guidance for complete obstruction by stones while the contrast agent cannot transit. Pneumatic or ultrasonic probes were used throughout ureterorenoscopy for lithotripsy. The ureteral stents and nephrostomy tube were placed at the end of the procedure. Mean drop in hemoglobin, operative time, success rate, hospital stay, and complications were assessed.
Mini-PCNL operations were performed successfully in all patients. Mean operation time was 37 min. Mean postoperative hospital stay was 3.6 days. All cases were followed up for 6-20 months. No major complications like hemorrhage, perforation or organic injury were noted during the operation or postoperatively. The stone-free rate in all patients was 95.7%. Calculus had no recurrence during the follow-up period. Hydronephrosis and hydroureterosis disappeared or were relieved.
Mini-PCNL is a safe and effective therapy for large impacted proximal ureteral stones.
评估微创经皮肾镜取石术（mini-PCNL）治疗大型嵌顿性近端输尿管结石的疗效和安全性。
我们回顾性分析了2006年1月至2010年8月期间接受mini-PCNL治疗的163例患者的治疗结果。患者平均年龄48.6岁，平均结石大小为18.4mm。所有患者均出现肾积水和/或输尿管积水。患者取俯卧位，在X线透视引导下或结合超声引导，将穿刺针置入目标肾盏，建立经皮通道（16F鞘），用于完全性结石梗阻且造影剂无法通过的情况。输尿管肾镜检查全程使用气压弹道或超声探头进行碎石。手术结束时放置输尿管支架和肾造瘘管。评估血红蛋白下降平均值、手术时间、成功率、住院时间及并发症情况。
所有患者mini-PCNL手术均成功完成。平均手术时间为37分钟。术后平均住院时间为3.6天。所有病例均随访6 - 20个月。术中及术后均未发现大出血、穿孔或器质性损伤等严重并发症。所有患者结石清除率为95.7%。随访期间结石无复发。肾积水和输尿管积水消失或减轻。
Mini-PCNL是治疗大型嵌顿性近端输尿管结石的一种安全有效的方法。
