经皮肾镜大功率钬激光碎石术治疗复杂性肾结石疗效分析

Efficacy Analysis of Complex Renal Calculi by Percutaneous Renal Microscope High-power Holmium Laser Lithotripsy

目的：观察对复杂性的肾结石患者予以微造瘘下经皮肾镜行钬激光碎石的临床效果。方法自2008年11月～2012年11月以来，治疗的136例复杂性的肾结石患者临床资料进行回顾性分析。结果118例患者一期行单通道的碎石取石：在术后的5-7天予以泌尿系平片的复查，其中108例结石达到一次取净，其一期清石率约为79.4％（108/136），其余10例为残留的小结石，予以体外的震波碎石。4例行中转开放式手术：其中2例患者术中出血较明显，以致视野模糊，经剥皮鞘后压迫5 min即好转，而继续操作却仍见出血，遂决定予以二期手术，而患者家属则要求实施开放式手术取石；其中2例由于通道迷失予以再次穿刺，但失败后中转为开放式手术。14例由于结石残留的较多行二期的碎石或者取石。其手术时间为105～220 min，（119.8＆#177;40.5）min。其术后住院为8～13天，（11.5＆#177;1.8）天。全部患者均未予双通道以及多通道的取石，均未出现肠管损伤或者胸膜损伤等临床并发症，均未出现穿刺失败，均未出现术中以及术后的大出血，没有输血，并且无一例出现术后的感染。136例经随访6～30个月，（19.5＆#177;8.5）月，有6例出现结石复发，经体外的震波碎石后均治愈。结论对复杂性的肾结石患者予以微造瘘下经皮肾镜行钬激光碎石，不仅高效安全，而且具有创伤小，与出血少，以及恢复快，和结石的清除率高等优点。

Objective Observe the clinical effect of the holmium laser via percutaneous renal mirror line of the com -plexity of patients with kidney stones to be reno.Methods A retrospective analysis of hospital treatment in our depart-ment since November 2008 to November 2012 , 136 cases of the complexity of the clinical data of patients with kidney stones.Results 118 cases of patients with a line single -channel gravel stone be plain film review of the urinary tract：in 5~7 days after surgery , which 108 cases of stone to take the net , one phase of the stone clearance rate of about 79.4%（108/136）, the remaining 10 cases for the residual small stones , be shock wave lithotripsy in vitro.4 cases converted to open surgery：two cases of patients with blood loss was more pronounced , resulting in blurry vision , and op-pression of the 5-minute improvement after stripping the sheath , and continue still see bleeding , he decided to be the second stage surgery , while the family members of patients requires the implementation of open surgical stone removal ;two cases due to be re-puncture channel lost , but converted to open surgery after the failure.14 cases due to residual stones of two of the more lines of gravel or stone.Its operative time was 105~220 minutes （119.8±40.5 ） minutes.Postoperative hospital stay was 8~13 days （11.5±1.8 ） days.All patients were not dual -channel and multi -channel stone, none of the clinical complications of bowel injury or pleural injury , no puncture failure, none of the intraoperative and postoperative bleeding , no blood transfusion , and none postoperative infection.136 cases were followed up for 6-30 months （19.5 ＆#177;8.5） months, six cases of stone recurrence were cured after in vitro shock wave lithotripsy.Conclusions Of the complexity of kidney stones in patients with percutaneous nephrolithotomy in reno line holmium laser lithotripsy , not only efficient and safe , and with less trauma and less bleeding and quicker recovery , and the stone clearance rate , etc.