微创经皮肾造瘘钬激光碎石治疗上尿路结石(附368例报告)

Treatment of upper urinary calculi with Ho:YAG laser lithotripter by minimally invasive percutaneous nephrolithotomy(A report of 368 cases)

目的探讨经皮肾穿刺微造瘘输尿管肾镜下钬激光治疗上尿路结石方法及疗效。方法采用经皮肾穿刺微造瘘输尿管肾镜下钬激光碎石处理上尿路结石368例。其中肾结石267例,肾结石并输尿管上段结石12例,输尿管上段结石89例。结果356例一期手术取石,12例二期手术取石;单通道取石322例,双通道取石42例,三通道取石4例,34例术后辅以ESWL治疗;一次结石清除率67.1%(247/368例),总的结石清除率90.7%(334/368),严重并发症发生率1.9%(7/368),平均住院天数10d,平均手术时间2h,平均尿液转清时间3d。结论经皮肾穿刺微造瘘输尿管肾镜下结合钬激光碎石治疗上尿路结石具有创伤小,并发症少,疗效好,恢复快,结石清除率高等优点,是治疗上尿路结石的理想方法,具有广阔的应用前景。

[Objective] To evaluate the efficacy and safety of minimally invasive percutaneous nephrolithotomy with Ho： YAG laser on the treatment of upper urinary calculi. [Methods] 267 cases of renal calculi patients, 89 cases with upper ureteral calculi and 12 cases with renal calculi combined with upper ureteral calculi were treated with minimally invasive pereutaneous nephrolithotomy with Ho： YAG laser. [Results] 356 cases underwent onestage procedure, another 12 cases underwent two stages. Stone was removed by single tract for 322 cases, two tracts for 42 cases and three tracts for 4 cases. After the operation,34 cases were treated by ESWL. The stone-free rate was 67,1% and total stone-free rate was 90.7%, meanwhile the rate of severe complication was 1.9%.The average stay in hospital was 10 days, the average time of operation was 2 hours and the average time of blood urine was 2 days. [Conclusions] m-PCNL has the advantages of mini-invasivemess, less complication, easy recovery, high stone-free rate. It can be considered as the first choice of treatment of upper urinary calculi.