经皮肾镜联合输尿管软镜碎石术治疗鹿角形肾结石体会

Combined percutaneous nephrolithotomy and lithotripsy through flexible ureteroscope in the treatment of staghorn calculi

目的总结单一微通道经皮肾镜碎石术（MPCNL）联合输尿管软镜碎石术治疗鹿角形。肾结石的临床经验体会。方法57例鹿角形肾结石均采用MPCNL和输尿管软镜碎石术联合治疗。结石大小（2．7cm×3．3cm～3．8cm×5．2cm），平均3．7cm×4．1cm。结果46例鹿角形结石一期碎石、取石成功，平均手术时间128min，平均出血量80mL（20～150mL），结石清除率为80．7％；11例残余结石主要集中于肾下盏，少部分位于肾中盏，于术后1个月行二期输尿管软镜碎石术，平均手术时间为57min，结石总清除率为93％（53／57）。4例术后仍有少量结石残留，大小为0．4～0．8cm，予以体外冲击波碎石术（ESWL）治疗，随访3个月，结石清除2例。结论MPCNL联合输尿管软镜碎石术治疗鹿角形肾结石可有效提高结石清除率，减少创伤及并发症。

Objective To summarize the clinical experience of combined single-access minimally inva- sive pereutaneous nephrolithotomy （MPCNL） and lithotripsy through flexible ureteroscope in the treatment of staghorn calculi. Methods Fifty-seven cases of renal staghorn calculi underwent combined MPCNL and lithotripsy through flexible ureteroscope. The size of calculi was （2.7 cm× 3.3 cm - 3.8 cm× 5.2 cm）, 3.7 cm × 4. 1 cm on average. Results The success rate of stone fragmentation was 80.7% （46/57） after the first stage of operation, duration of which was 128 min on average. The average loss of blood was 80 mL （20 - 150 mL）. Eleven patients with residual calculi in the middle and lower calyx were also underwent the second stage of operation after 5 - 7 days. The average operation duration of the second stage was 57 rain and the total clearance rate was 93% （53/57）. Four cases had a few of residual calculi with size of 0. 4 -0.8 cm and went on with the treatment of extracorporeal shock wave lithotripsy（ESWL）. Two cases were stone-free in the follow-up for 3 months. Conclusion MPCNL combined with lithotripsy through flexible ureteroscope on the treatment of staghorn calculi can decrease the therapeutic risk and complication, increase the rate of stone-free and safety.