侧卧位微创经皮肾镜取石术治疗输尿管上段结石

             作者：梁坚，李文雄，李峻，罗力，王森，王忠，曹明欣 

【摘要】  目的 探讨侧卧位微创经皮肾镜取石术治疗输尿管上段结石的临床应用价值。方法 回顾性分析我院2007年1月～12月采用侧卧位微创经皮肾镜取石术治疗输尿管上段结石25例的临床资料，均为单侧结石，合并肾结石6例，KUB测得结石最大经1.0～2.7 cm。结果 本组平均手术时间45 min（25～90 min）,平均住院8 d (5～12 d)。22例单通道一期手术，3例因术中发现肾积脓，留置造瘘管后改二期手术。术前血红蛋白（114±25）g/L，一期手术后1～3 d检查血红蛋白（112.5±23.5）g/L。术后高热2例。总结石排净率100%。无大出血和其他严重并发症发生。结论 侧卧位对患者比较舒适，对外科医生的术中操作和麻醉师的术中观察都比较方便，值得临床推广使用。

【关键词】  输尿管上段结石；经皮肾穿刺取石术；侧卧位

　　Abstract: Objective To explore the clinical value of minimally invasive percutaneous nephrolithotomy (mPCNL) in lateral decubitus position in the management of upper ureteral calculi. Methods 25 patients were analyzed retrospectively, who suffered from upper ureteral calculi and were treated with minimally invasive percutaneous nephrolithotomy in lateral decubitus position between January 2007 and December 2007. These patients included 18 men and 7 women, with an average age of 38yearsold (23 to 65 years). All patients’ ureteral calculi were unilateral and 6 cases were combined with kidney calculi. The diameter measured by KUB ranged from 1.0 cm to 2.7 cm. Results The mean operative duration was 45 min (ranging from 25 to 90 min) and the average hospital stay lasting for 8 days (ranging from 5 to 12 days). 22 cases were treated with only one percutaneous access tract in a single session and 3 cases were only placed stoma tube and underwent a secondlook procedure because of pyonephrosis. The average preoperative hemoglobin was （114±25）g/L. On the first to third postoperative day, hemoglobin was reexamined, with an average of （112.5±23.5）g/L. 2 cases had high fever postoperatively. The stonefree rate was 100%. Excessive hemorrhage and other severe complications did not occur. Conclusions  The lateral decubitus position, the most familiar to urologists, is also an ideal position for mPCNl in the management of upper ureteral calculi. It adds ease and comfort to the patient, anesthesiologist, and surgeon.

　　Key words:upper ureteral calculi; percutaneous nephrolithotomy; lateral decubitus position

　　输尿管上段大结石和嵌顿包裹性结石是体外冲击波碎石术(ESWL)和输尿管镜较难处理的结石，应首选微创经皮肾镜取石术治疗。由于传统的经皮肾镜手术体位多采用俯卧位进行手术，病人比较辛苦，也给麻醉观察带来不便。我科近10年在熟练掌握俯卧位手术技巧的基础上，进行了