经皮肾镜钬激光联合超声碎石治疗鹿角形肾结石:附36例报告

Percutaneous nephrolithotomy combined holmium laser with ultrasound for treatment of renal staghorn stones:A report of 36 cases

目的探讨经皮肾镜取石术(PCNL)钬激光联合超声碎石治疗鹿角形肾结石的可行性和疗效。方法 2010年4月至2011年5月,我院共对36例鹿角形肾结石实施了PCNL钬激光联合超声碎石治疗。首先建立22F的手术通道,钬激光快速将结石击碎为10mm内碎石,再通过超声碎石将结石清除,对于需要建立的的其他通道均采用18F或16F的微通道。结果手术均取得成功,单通道取石29例,双通道取石7例,平均手术时间105min。一次手术取净结石26例(72.2%),二次手术联合体外冲击波碎石取石术(ESWL)治疗7例。术后随访1～3个月,总无石率91.7%,无严重并发症发生。结论 PCNL联合钬激光和超声碎石治疗鹿角形肾结石具有清石效率高、手术时间短、无石率高、并发症少等优点。

Objective To investigate the feasibility and effectiveness of percutaneous nephrolithoto- my （PCNL） through the combination of holmium laser and ultrasound for treatment of renal staghorn stones. Methods From April 2010 to May 2011, a total of 36 patients with renal staghorn stones underwent PCNL combind holmium laser with ultrasound. First, 22 F channeles were eslablished and stones crushed to frag- ments （〈10 mm） with holmium laser. Then, ultrasound was used to remove fragments. 18 F or 16 F channel were adopted for other accesses. Results All surgeries were successfully performed, 29 through a single tract, 7 through two tracts respectively. The average time of lithotripsy was 105 min. No significant compli- cations were observed. Conclusions Percutaneous nephroslithotomy with holmium laser and uhrasoun could reduce the duration of operation. It is cfective and safe for complicated kidney stones. The combina- tion of holmium laser and ultrasound deserves being used in PCNL for renal staghorn stones.