复杂性上尿路结石微创综合治疗的临床应用研究

Clinical Study of Combination Therapy in Minimally Invasive Techniques for Complex Upper Urinary Tract Calculi

目的:探讨和总结上尿路结石微创综合治疗的有效方法和经验。方法:采用经皮肾微造瘘输尿管镜取石术(MPCNL)、逆行输尿管镜碎石术(URL)、体外冲击波碎石术(ESWL)等方法治疗复杂性上尿路结石患者52例,其中采用MPCNL治疗52例,俯卧位44例,侧卧位8例;采用URL治疗31例;采用ESWL治疗16例。最大结石直径1.7～4.0 cm,平均(2.40±0.07)cm。结果:52例患者住院天数9～22天,平均(15.27±0.46)天。Ⅰ期结石清除率71.1%(37/52),Ⅱ期结石清除率60.0%(9/15),总的结石清除率88.5%(46/52);Ⅰ期结石清除率与总的结石清除率比较,差异有统计学意义(P<0.05)。其中15例肾功能不全患者术前肌酐平均值为(326.87±63.28)mmol/L,术后1～3个月拔管后血肌酐平均值为(142.60±28.53)mmol/L,二者比较差异有统计学意义(P<0.05)。术中无气胸、腹腔脏器损伤等并发症发生。最后6例有残余结石,术中大出血3例(5.7%),肾对穿(孔)2例,输尿管穿孔2例(7.7%),尿外渗5例(9.6%),术后休克1例(1.9%),发热9例(17.3%)。结论:在治疗复杂性上尿路结石患者的过程中,制定个体化微创综合治疗方法非常重要,可以明显提高结石清除率,有效保护和改善肾功能,减少机体损伤以及其他并发症发生。

Objective：To investigate and summarize the effectiveness of combination therapy in minimally invasire techniques for complex upper urinary tract calculi. Methods：A total of 52 patients with complex upper urinary tract calculi treated by minimally invasive percutaneous nephrolithotomy （MPCNL）, ureterorenoscope lithotripsy （URL）,extracorporeal shock wave lithotripsy （ESWL）, 52 cases were treated with MPCNL, 44 cases in prone position, 8 cases in lateral positions 31 cases were treated with URL,16 cases were treated with ESWL. The largest stone diameter was from 1.7 to 4.0 cm （the average 2. 40±0.07 cm）. Results：52 patients hospitalized 9 22 days, and the mean hospital stay was（ 15.27± 0.46）days. The stone-free rate of stage I was 71.1% （37/52）, the stone-free rate of If period was 60. 0% （9/15）, the overall stone-free rate was 88. 5 % （46/52）. The total stonefree rate had a statistically higher result than that of the stone-flee rate of stage I （P〈0.05）. Of which 15 eases of renal insufficiency in patients with mean preoperative creatinine （326.87±63.28） mmol / L, serum creatinine after extubation after 1 to 3 months the average （142.60±28. 53） mmol / L. the difference was statistically sig- nificant（P〈0.05）. Severe complications did not occur during operations. Other complications were intraoperative massive hemorrhage in 3 （5.7% ）Intraoperative foration of the renal pelvis in 2 and of the ureter in 2（7.7 % ）, urinary extravasation in 5 （9.6 % ）, shock in 1 （1.9 % ）, fever in 9 （17.3% ）. Conclusions： Treat the patients with complicated upper urinary tract stones need to develop a comprehensive individualized minimally invasive treatment methods combined. It can significantly improve stone clearance rate, the effective protection and improvement of renal function, reduce body damage and reduce the incidence of other complications.