单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石的手术效果研究

Clinical Efficacy of the Single-channel Percutaneous Nephrolithotomy Pneumatic Lithotripsy Combined With Flexible Ureteroscope Holmium Laser Lithotripsy in Treatment of Staghorn Renal Calculi

目的分析单通道经皮肾镜气压弹道碎石联合输尿管软镜钬激光碎石治疗鹿角状肾结石的临床效果和安全性。方法选择2014年6月~2015年6月我院收治的鹿角状肾结石患者32例进行研究,入选患者均接受单通道经皮肾镜气压弹道碎石联合输尿管软镜钬激光碎石术治疗,结石大小（2.9×3.4 cm2~3.8×5.4 cm2）,平均大小为（3.5×4.3）cm2。结果患者均接受二期治疗,一期选择单通道经皮肾镜气压弹道碎石术,二期联合输尿管软镜钬激光碎石术治疗。一期手术平均时间为（120.0±24.3）min,结石清除率81.2%;二期手术平均时间为（45.0±7.2）min,总结石清除率为90.6%。二期治疗后有3例患者有结石残留,结石直径0.2~0.9 cm,这3例患者在术后均接受ESWL治疗,术后随访3~6月,结果显示结石全部清除。结论单通道经皮肾镜气压弹道碎石联合输尿管软镜钬激光碎石治疗鹿角状肾结石,疗效理想,且手术创伤小、并发症少、手术时间短、安全性高等优点,可作为鹿角状肾结石的首选治疗方法。

Objective To analyze clinical efficacy of the single-channel percutaneous nephrolithotomy pneumatic lithotripsy combined with flexible ureteroscope holmium laser lithotripsy in treatment of Staghorn renal calculi. Methods 32 patients with staghorn calculi in hospital from June 2014 to June 2015 were selected. Patients were treated with single-channel percutaneous nephrolithotomy pneumatic lithotripsy combined with flexible ureteroscope holmium laser lithotripsy,stone size was（2.9×3.4 cm2~ 3.8×5.4 cm2）,average size was（3.5×4.3）cm2. Results The patients were received two treatment. One surgery was selected by Single-channel percutaneous nephrolithotomy pneumatic lithotripsy. Two surgery was treated by flexible ureteroscope holmium laser lithotripsy. One mean operation time was（120.0±24.3）min,stone clearance rate was 81.2%; two operative averaging time was（45.0±7.2）min,summary stone clearance rate was 90.6%. Three patients were residual stones after the second phase of treatment,stone diameter was 0.2 to 0.9 cm,3 patients were treated wuth ESWL after surgery. Patients were followed up for 3 to 6 months,the stones were cleared. Conclusion Single-channel percutaneous nephrolithotomy pneumatic lithotripsy combined flexible ureteroscope holmium laser lithotripsy have a good effect,small surgical trauma,fewer complications, shorter operative time,safety,etc. It can be used as the preferred method for staghorn kidney stones.