本文選題：微創(chuàng)經(jīng)皮腎鏡取石術(shù) + 腎結(jié)石��； 參考：《廣州醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：探討B(tài)超引導(dǎo)下微創(chuàng)經(jīng)皮腎鏡取石術(shù)（MPCNL）治療伴有輕度腎積水的小體積（直徑1～2cm）的腎結(jié)石或輸尿管上段結(jié)石的有效性和安全性。 病人與方法：前瞻性分析2012年3月～2013年9月由我科同一位醫(yī)生主治的90例直徑1～2cm的伴有輕度腎積水的腎結(jié)石或輸尿管上段結(jié)石患者，均于俯臥位下行B超引導(dǎo)下微創(chuàng)經(jīng)皮腎鏡取石術(shù)。對(duì)通道建立、手術(shù)時(shí)間、術(shù)中術(shù)后并發(fā)癥及結(jié)石清除率進(jìn)行臨床分析。 結(jié)果：90例患者均在B超引導(dǎo)下成功建立經(jīng)皮腎通道。87例患者順利完成I期MPCNL，，3例因膿腎、心肺功能欠佳行I期造瘺、II期取石。穿刺時(shí)間5～15min，平均7±2.1min；手術(shù)時(shí)間為10～80min，平均40±15.6min。I期MPCNL術(shù)后復(fù)查有80例（88.9%）結(jié)石清除，其中結(jié)石完全清除72例，臨床無(wú)意義殘余結(jié)石8例；有臨床意義殘余結(jié)石10例，分別行II期MPCNL、體外沖擊波碎石（ESWL）和內(nèi)科排石。并發(fā)癥發(fā)生率為20％（18/90），包括感染發(fā)熱（T＜38.5℃3例、T≥38.5℃2例）、術(shù)后出血、血紅蛋白顯著降低3例、輕度疼痛7例，中重度疼痛需要鎮(zhèn)痛處理者3例，住院期間未發(fā)生臟器損傷、尿瘺、血?dú)庑氐绕渌l(fā)癥。 結(jié)論：B超引導(dǎo)下微創(chuàng)經(jīng)皮腎鏡取石術(shù)治療伴有輕度腎積水的1～2cm腎結(jié)石或者輸尿管上段結(jié)石是安全和有效的，成功率、取石率高，并發(fā)癥可接受。B超引導(dǎo)下微創(chuàng)經(jīng)皮腎鏡取石術(shù)是治療此類結(jié)石的重要方法之一。
[Abstract]:Objective: to evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy (MPCNL) guided by B-ultrasound in the treatment of renal calculi with mild hydronephrosis (1: 2 cm in diameter) or upper ureteral calculi. Patients and methods: from March 2012 to September 2013, 90 1~2cm patients with mild hydronephrosis or upper ureteral calculi were analyzed prospectively. Minimally invasive percutaneous nephrolithotomy under the guidance of B-ultrasound was performed in prone position. Clinical analysis was made on channel establishment, operation time, intraoperative and postoperative complications and stone clearance rate. Results under the guidance of B-ultrasound, all 90 patients were successfully established the percutaneous renal passage. 87 patients completed stage I MPCNL successfully. 3 patients with stage I MPCNL underwent stage II lithotomy because of pyonephrosis and poor cardiopulmonary function. The mean time of puncture was 7 鹵2.1 min (mean 7 鹵2.1 min), the operative time was 10 min (80 min) and the average time was 40 鹵15.6min.I (80 cases) after MPCNL.) among them, 72 cases were completely removed, 8 cases were clinically meaningless residual stones, 10 cases had clinical significance residual stones. Stage II MPCNL, extracorporeal shock wave lithotripsy (ESWL) and internal lithotomy were performed. The incidence of complications was 20: 18 / 90, including infection fever T < 38.5 鈩

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