微创经皮肾穿刺肾镜结合胆道镜取石术治疗复杂性上尿路结石

Treatment of upper urinary calculi with minimally invasive percutaneous nephrolithotomy combined with choledochoscope under the guide of ultrasound

目的探讨超声引导微创经皮肾穿刺肾镜结合胆道镜取石术治疗复杂性上尿路结石的手术方法及效果。方法采用微创经皮肾穿刺肾镜结合胆道镜取石术治疗复杂性上尿路结石患者15例,探讨手术方法评价治疗效果。结果本组15例手术时间为45～180min,平均105min,一期结石清除9例,二期结石清除4例,结石总取尽率86.7%(13/15),1例于术后1个月辅以体外碎石治疗,结石排净;总的结石排净率为93.3%。无中转开放手术,无严重并发症。结论微创经皮肾穿刺肾镜结合胆道镜取石术治疗上尿路结石具有安全有效、损伤小、结石清除率高等优点,可作为复杂性上尿路结石的治疗方法。

[Objective] To evaluate the feasibility and availability of minimal invasive percutaneous nephrolithotomy（MPCNL） combined with choledochoscope under the guide of ultrasound on multiple upper urinary calculi.[Methods] 15 cases of upper urinary calculi including 9 males and 6 females were selected to be treated by MPCNL combined with choledochoscope using holmium laser.The procedures and availability were analyzed respectively.[Results] Among 15 cases,the operative duration was 105 min（45-180 min）.9 cases were stone free after one stage MPCNL,4 cases were stone free after two stage mPCNL,1 case was stone free treated by ESWL 1 month after MPCNL.The total stone free rate was 93.3%.No severe complications were observed.[Conclusions] MPCNL combined with choledochoscope offers advantages with respect to easy operation,less invasion,less complications,easy recovery,high stone free rate.It＇s a good minimally invasive way in treatment of complicated upper urinary calculi.