标准通道联合微通道经皮肾镜治疗复杂性肾结石疗效分析

Percutaneous Nephrolithotomy Combined with Minimally Invasive Percutaneous Nephrolithotomy for Large and Complex Renal Calculi

目的总结标准通道联合微通道经皮肾镜治疗复杂性肾结石的手术经验及其并发症的防治。方法回顾性分析采用标准通道联合微通道经皮肾镜治疗复杂性肾结石441例（461例次）的临床资料。结果平均手术时间70 min;住院时间8－28 d,平均11 d。采用三通道取石2例,二通道取石20例,单通道取石419例。一期手术术前血红蛋白（115±26）g.L^-1、1－3 d内复查血红蛋白（96±21）g.L^-1,术中损伤腹膜3例、损伤十二指肠1例,术后高热8例、感染性休克3例、急性肾功能不全5例,术后需配合体外震波碎石（ESWL）35例。结石总排除率92%。结论标准通道联合微通道经皮肾镜治疗复杂性肾结石,具有创伤小、恢复快、患者易接受、治疗好,并发症少等优点,但术中术后要注意并发症的预防。

Objectives To summarize the surgical management of large and complex renal calculi by percutancous nephrolithotomy（PCNL） combined with minimally invasive percutaneous nephrolithotomy（MPCNL）.Methods The clinical data of 441 patients（461 renal units） with large and complex renal calculi who underwent PCNL combined with MPCNL were retrospectively reviewed.Results The average operation time was 70 minutes.The average hospital stay was 11 days（range from 8 to 28 days）.The number of tracts required per procedure was 3 in 2 cases,2 in 20 cases,and 1 in 419 cases.The average preoperative hemoglobin level was（115±26）g·L^-1,and the level was（96±21） g·L^-1 1-3 days after first look procedure.Complications were peritoneal injury in 3 cases,duodenal injury in 1,high fever in 8,septic shock in 3,and acute renal failure in 5.In addition,extracorporeal shock wave lithotripsy was used to treat residual stones in 35 patients.The overall stone-free rate was 92%.Conclusion PCNL combined with MPCNL for treating large and complex renal calculi has advantages of less trauma,rapid recovery and fewer complications.However,attention should be paid during and after surgery to prevent complications.