开放手术配合腔内碎石技术治疗孤立肾复杂结石11例报告

Combination of Endoscopic Lithotripsy Techniques and Open Operation of Complicated Renal Calculi for 11 Cases of Solitary Kidney

目的探讨气压弹道、钬激光等腔内碎石技术在孤立肾复杂结石开放手术中的应用价值.方法11例孤立肾复杂结石患者行开放手术治疗,术中经输尿管镜气压弹道或钬激光碎石、取石.结果11例患者均顺利完成手术,9例一次取净结石,2例术中结石残留,总结石取净率为81.5%(9/11).残余结石患者中1例行ESWL治疗排净,另外1例残余结石行PCNL治疗取尽.术中出血少,术后无严重并发症发生.结论在复杂孤立肾结石治疗中采用开放手术配合使用腔内碎石技术具有最大限度保护肾功能、减少手术创伤和风险、降低术后并发症、提高结石取净率等优点,值得推广应用.

Objective To evaluate the clinical application value of endoscopic lithotripsy techniques such as pneumatic lithotripsy or Holmium laser in open operation for complicated renal calculi of solitary kidney.Methods 11 patients of complicated renal calculi of solitary kidney were treated by open operation.All patients were treated by ureteroscopic pneumatic lithotripsy or holmium：YAG laser lithotripsy during operation.Results The operation was completed smoothly in all the 11 patients.Stones were completely cleared away in 9 cases,while residual stones were found in 2 cases.The overall stone clearance rate was 81.8%（9/11）.One case that had residual stone was treated by ESWL postoperatively and the other received PCNL.The residual stone of 2 cases were cleared out.Blooding is less during operation and no severe postoperative complications were found.Conclusion The combined application of open surgery and endoscopic lithotripsy techniques for complicated renal calculi of solitary kidney has the merits such as protecting the renal function as good as possible,reducing operative trauma and risk,decreasing the occurance of complications and improving the rate of cleaning stones.This method is worthy of spreading to application.