微创经皮肾镜取石术治疗上尿路结石临床分析

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1、-上海交通大学硕士论文第二部分微创经皮肾镜取石术治疗嵌顿输尿管上段结石临床分析摘要目的评价微创经皮肾镜取石术(minimalinvasivepercutaneousnephrolithotomy，mPCNL)治疗嵌顿输尿管上段结石的有效性和安全性。方法2004年2月～2007年10月应用微创经皮肾造瘘，输尿管镜直视下气压弹道或钬激光碎石治疗98例嵌顿输尿管上段结石，对结石清除率和并发症等进行统计分析。结果98例均为Ⅰ期穿刺成功取石，结石清除率为100%；手术时间55～75min，平均62min；碎石、取石时间

2、15～35min，平均26min；术后住院4～7天，平均6天；术后体温>38.5℃以上6例，未出现严重并发症；72例随访3～24个月，无输尿管狭窄及结石残留、复发。结论微创经皮肾镜取石术治疗嵌顿输尿管上段结石操作简单，快速清除结石，解除梗阻，对肾脏损伤小，并发症少，术后恢复快，临床上可以广泛推广。关键字输尿管上段结石，微创，经皮肾镜取石---上海交通大学硕士论文CLINICALANALYSISOFMINIMALLYINVASIVEPERCUTANEOUSNEPHROLITHOTOMYINTREATMENTOF

3、KINDNEYCALCULUSABSTRACTOBJECTIVETheapproachtourinarystonediseasehaschangeddramaticallyoverthelastthreedecadeswithatransitionfromopensurgerytominimallyinvasiveprocedures.Percutaneousnephrolithotripsy(PCNL)isacornerstoneofthetreatmentofkidneyandcontinuestoevo

4、lvewithadvancesintechniquesandinstrumentation.minimallyinvasivepercutaneousnephrolithotomy(mPCNL)developedfastlyinchina.ThepurposeofthisstudywastoassesstheefficacyandthesaftyofmPCNLinthetreatmentofkindneycalculusandgiveoutcomesandtrendsofthistechnology.METH

5、ODSFromApril2004toDecember2007，222casesofkindneycalculusincludingpelviccalculus43cases，calycealcalculus78cases，multiplecalculus31cases，particalstaghorncalculus38casesandtotalstaghorncalculus32casesunderwentmPCNLatourinstitute，theclinicaldatasaboutoperativet

6、ime，stoneclearancerateandoperativecomplicationswereretrospectivelyanalysed.---上海交通大学硕士论文RESULTSIn222cases，Theyweretreatedwithone-stageoperationin199cases(89.6%)，two-stagein23cases(10.4%)，ofwhichsinglechannelwasusedin206cases(92.8%)，two-channelin16cases(7.2%

7、).Completestoneclearancewasachievedin188renalunits，givinganoverallclearancerateof84.7%.Theaverageoperativetimewas87minutes.Thedurationofhospitalizationwas5to8dayswithanaverageof6.5daysinone-stagestone-freeclearancepatients.22patients(8.98%)compcatiedwithfev

8、er(>38.5℃)afteroperation.Urinrytractinfection(UTI)(T>38.5℃，>2days)afteroperationwasseenin12patients(4.89%)；6(2.45%)patientsrequired400mlbloodtransfusionafteroperation.3patientscomplicatedwithsevereblee