F_(16)单通道微创经皮肾镜联合输尿管软镜治疗复杂鹿角形肾结石

F_(16) Single-tract Minimally Invasive Percutaneous Nephrolithotomy Combined with Flexible Ureteroscopy for the Treatment of Complex Renal Staghorn Calculi

目的探讨F16单通道微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）联合输尿管软镜治疗复杂鹿角形肾结石的临床疗效和安全性。方法我院2009年5月~2012年9月对35例复杂鹿角形肾结石一期行F16单通道微创经皮肾镜取石术,术后5~7 d行二期MPCNL联合输尿管软镜碎石术,结石粉碎后由一期通道冲出,术后KUB提示结石仍有残余者3~5 d后行三期MPCNL联合输尿管软镜碎石术。结果 21例二期输尿管镜碎石后结石完全清除,12例三期MPCNL联合输尿管软镜碎石后结石完全清除,2例少量残余结石给予药物排石,术后1个月随访结石排出。均无大出血、感染性休克等严重并发症。35例术后3~6个月随访,均无结石残留或复发。结论单通道MPCNL联合输尿管软镜是处理复杂鹿角形结石的一种安全有效的方法。

Objective To evaluate the efficacy and safety of application of F16single-tract minimally invasive percutaneous nephrolithotomy（ MPCNL） combined with flexible ureteroscopy for the treatment of complex renal staghorn calculi. Methods From May 2009 to September 2012,35 patients with complex renal staghorn calculi were treated by F16single-tract MPCNL combined with flexible ureteroscopy in this hospital. All the patients underwent MPCNL at the first-stage,and 5- 7 days afterwards a second-stage operation was performed by using flexible ureteroscopy. The fragments of stones were removed from the MPCNL tract. For patients diagnosed as having residual stones,a third-stage reoperation of MPCNL combined with flexible ureteroscopy was given. Results Twenty-one patients were stone-free after the second-stage operation,12 patients were stone-free after the third-stage operation,and the remaining 2 patients with residual stones were given drug administration for stone removal and were clarified as stone-free within 1month of follow-up. No serious intraoperative or postoperative complications such as hemorrhage or infectious shock occurred. Followup reviews for 3- 6 months in the 35 patients found no residual stones or recurrence. Conclusion F16single-tract MPCNL combined with flexible ureteroscopy is an effect and safe procedure for complex renal staghorn calculi.