膀胱软镜在复杂性肾结石经皮碎石中的临床观察

Effect of flexible cystoscope in percutaneous nephrolithotomy for complex renal calculi

目的探讨膀胱软镜在复杂性肾结石经皮碎石中的临床应用效果。方法我科2008年10月至2011年4月间,选取单侧或双侧肾脏复杂性结石患者68例,经皮肾穿刺,建立20号大小手术通道,插入肾镜,三代超声气压弹道(EMS)碎石,再置入膀胱软镜,寻找各盏残余结石,钬激光将结石粉碎并冲出碎石屑。对照组50例,单用经皮肾镜治疗,超声气压弹道碎石排出。术后均保留肾造瘘管3～5d,尿管5～7d,双J管4～8周。结果 68例患者手术时间62～167min,平均(76.5±7.5)min;出血量(48.5±10.1)mL;术后住院时间6～11d,平均(8.22±1.2)d;术后出血5例。与对照组比较,新术式一期手术时间稍长,术后恢复时间、疼痛症状均无显著性差异(P>0.05)。一期手术结石清除率为94.7%,对照组为77.5%,结石清除率明显提高(P<0.05),术中出血量较少、术后并发症明显改善(P<0.05)。结论在复杂性肾结石中,膀胱软镜联合经皮肾镜的治疗是可选择的,其疗效微创、安全、有效。

Objective To evaluate the clinical effect of flexible cystoscope in percutaneous nephrolithotomy for complex renal calculi.Methods Data of 118 cases of unilateral or bilateral complex renal calculi treated during Oct.2008 to April 2011 were retrospectively analyzed.The 118 cases were randomly divided into two groups.The 50 patients in the control group were treated with percutaneous nephrolithotomy,Wolf F8.5/11.5.The 68 patients in the experimental group were treated with percutaneous nephrolithotomy combined with flexible cystoscope,Olympus CYF type-VA2.All procedures were performed under percutaneous puncture through F20 channel.After operation,renal fistula was maintained for 3～5 d,urethral catheter for 5～7 d,and double-J stent for 4～8 weeks in all cases.Results In the experimental group,mean operation time was（76.5±7.5） min,mean volume of blood loss was（48.5±10.1） mL,mean hospital stay was（8.22±1.2） d.5 cases developed hemorrhage after operation.Compared with the control group,there was no significant difference in the mean operation time,hospital stay and pain symptoms（P〈0.05）.The one-stage stone-free rates for the experimental and control groups were 94.7% and 77.5%,with significance（P〈0.05）.And there was difference in the volume of blood loss and serious complications（P〈0.05） between the two groups.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope is minimally invasive,effective and safe for complex renal calculi.