肾盂切开联合钬激光碎石术治疗复杂性肾结石体会

Pyelolithotomy Combined with Holmium Laser Lithotripsy for Complex Renal Calculi

目的比较肾盂切开联合钬激光碎石及传统肾盂肾窦肾实质切开取石治疗复杂性肾结石的疗效。方法回顾性分析65例复杂性肾结石的临床资料,其中行肾盂肾窦肾实质联合切开取石35例(A组),肾盂切开联合钬激光碎石30例(B组)。结果 A组出血量(288.5±81.3)ml,明显多于B组的(49.0±25.8)ml(P<0.05);A组血流阻断时间(30.2±22.6)min,而B组未行肾血流阻断(P<0.05)。两组手术时间、输血量、结石直径、术后并发症发生率比较无显著差异(P>0.05)。A组术后发生血尿2例,残石4例,无功能性肾萎缩2例;B组术后发生血尿3例,经对症处理均痊愈。结论肾盂切开联合钬激光碎石治疗复杂性肾结石符合微创发展趋势,术中出血少,对肾脏损伤小,是临床治疗复杂性肾结石一种可行的术式。

Objective To compare the effect of traditional pyelolithotomy and pyelolithotomy associated with holmium laser lithotripsy for complex renal calculi.Methods Clinical data of 65 complex renal calculi cases was reviewed.Among them,35 cases served as group A were treated by traditional pyelolithotomy,and 30 cases served as group B by pyelolithotomy associated with holmium laser lithotripsy.Results The blood loss of group A was（288.5±81.3） ml,and was more than（49.0±25.8） ml of group B（P0.05）.The renal blood flow blocking was performed in group A with the blocking time of（30.2±22.6） minutes,but not performed in group B（P0.05）.There was no statistical difference in operative time,transfusion volume,diameter of calculi and postoperative complication rate between two groups.2 of haematuria,4 of residual stone and 2 of non-functioning renal atrophy in group A and 3 of haematuria in group B were recovered by symptomatic treatment.Conclusion The treatment of pyelolithotomy associated with holmium laser lithotripsy can accord with the development tendency of minimally invasion with less blood loss and little damage of renal function,and is a feasible procedure for complex renal calculi.