斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗复杂性肾结石的疗效观察

Treatment of complex renal calculi by oblique lateral position and minimally invasive percutaneous nephrolithotomy using EMS combined with holmium laser under the guidance of rigid and flexible ureteroscope

目的探讨斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗复杂性肾结石的疗效及安全性。方法 2010年1月～2014年9月采用B超引导,斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗80例复杂性肾结石。结果本组80例,均成功行一期取石,其中57例结石完全清除;10例残留结石直径≤0.6cm;5例残石直径≥1.2cm,给予二期取石;8例残留结石直径0.6～1.2cm,给予体外冲击波碎石。术中平均出血125mL。7例术后出血,其中3例输血。68例患者术后合并不同程度血尿。5例术后发热,体温〉38.5℃,经抗感染治疗3～5d体温恢复正常。平均手术时间108 min。平均住院时间11.2d。结论斜侧卧位经皮肾微通道双镜指引下气压弹道联合钬激光治疗复杂性肾结石出血少、碎石清石效率高、并发症发生率低,是一种安全有效的治疗方法。

Objective To explore the clinical efficacy and safety of treating complex renal calculi by oblique lateral position and minimally invasive percutaneous nephrolithotomy using EMS combined with holmium laser under the guidance of rigid and flexible ureteroscope.Methods During Jan.1th,2010 and Sept.30 th,2014,80 cases of complex renal calculi were treated by oblique lateral position and minimally invasive percutaneous nephrolithotomy using EMS combined with holmium laser under the guidance of rigid and flexible ureteroscope.Results All cases were successful managed at the first stage;57 cases were stone-free;10 cases had residual stones≤0.5 cm;5 cases had residual stones≥1.2 cm,which went through secondstage lithotripsy;8 cases had residual stones between 0.6 ～1.2 cm,which were processed by extracorporeal shock wave lithptripsy（ESWL）.The intraoperative average blood loss was 125 mL.A total of 7 patients had postoperative bleeding,3 of whom needed blood transfusion.Hematuria occurred in 68 patients.Postoperative fever occurred in5 patients,with temperature more than 38.5 ℃,and they were cured with anti-infective therapy after 3～5 days.The mean operation time was 108 min.The patients were discharged from hospital after an average of 11.2 d.Conclusions EMS combined with holmium laser under the guidance of rigid and flexible ureteroscope by oblique lateral position and minimally invasive percutaneous nephrolithotomy produces perfect therapeutic effect in treating complex renal calculi,since this technique has advantages of less bleeding,higher efficiency and fewer complications.Therefore,it is one of the safe and effective methods for the treatment of complex renal calculi.