不同大小双通道经皮肾镜碎石治疗复杂性肾结石25例分析

Different size dual-tract PCNL treatment for complex renal calculi

目的探讨复杂性肾结石的有效微创治疗方法。方法 2009年5月至2010年4月广州军区武汉总医院采用标准通道和微通道、标准通道和标准通道双通道相结合的方式行经皮肾镜碎石术治疗复杂性肾结石25例,分析并发症和疗效,同时复习相关文献。结果 25例均一期成功建立皮肤肾脏通路,平均手术时间91 min;平均术后住院时间7 d;术中平均出血量50 mL;患者术中没有出现大出血、通道丢失、邻近器官损伤等并发症;术后未出现长时间血尿、漏尿、腰腹痛、发热、肾功能不全等并发症,25例均达到一期完全碎石的目的 (碎石率100%)。结论标准通道和微通道、标准通道和标准通道相结合的双通道经皮肾镜碎石术是治疗复杂性肾结石的有效治疗方法之一,穿刺和碎石技巧是成功的关键。

Objective To explore the effective minimally invasive treatment for complex kidney stones.Methods The efficacy and complications of 25 cases of complex renal calculi treated in our hospital with standard-micro and standard-standard tracts percutaneous nephrolithotomy（PCNL） during May 2009 to April 2010 were retrospectively analyzed and relevant literatures were reviewed.Results The primary skin-kidney channels were successfully established in all patients.The mean operation time was 91 minutes,the average postoperative hospital stay 7 days,and intraoperative blood loss 50 mL.During the operation,no complications such as bleeding,channel loss or damage on adjacent organs occurred.After the operation,no hematuria,urine leakage,flank pain,fever,renal insufficiency,and other complications were detected.All cases had 100% stone clearance with one session.Conclusions Combination of PCNL with both standard-micro and standard-standard tracts is effective to treat complex renal stones.