完全无管化经皮肾镜钬激光碎石术治疗上尿路结石42例

Totally Tubeless Percutaneous Nephrolithotomy with Holmium Laser in the Treatment of Upper Urinary Tract Calculi:Report of 42 Cases

目的探讨完全无管化经皮肾镜钬激光碎石取石术治疗上尿路结石的可行性及疗效。方法 2014年1月～2015年7月对42例上尿路结石B超引导下行微通道经皮肾镜钬激光碎石取石术,不留置肾造瘘管和双J管,观察手术时间、出血量、留置尿管时间、术后住院时间、结石清除率和并发症等。结果 42例均一期建立经皮肾镜微通道,钬激光碎石,均未留置肾造瘘管及双J管,无大出血或周围脏器损伤等严重并发症发生,无中转开放手术。手术时间30～110 min,（54.8±25.1）min;术中出血量20～150 ml,（44.5±18.5）ml;术后留置尿管3～5 d,（3.7±0.9）d;术后住院3～7 d,（4.0±1.0）d。术后复查KUB提示4例有小结石残留,无须特殊处理。42例随访3个月,均无继发大出血或严重感染等并发症发生。结论严格选择病例实施完全无管化PCNL是安全可行的,未增加术后相关并发症风险,完全有可能成为一些肾镜手术的选择方式。

Objective To evaluate the feasibility and efficacy of totally tubeless percutaneous nephrolithotomy（ PCNL） with holmium laser in the treatment of upper urinary tract calculi. Methods A total of 42 patients with upper urinary tract calculi strictly selected to meet the inclusion criteria and exclusion criteria received mini-PCNL by using holmium laser under the guidance of ultrasonography. Percutaneous drainage and double-J stenting were not used. The operation time, intraoperative blood loss,postoperative catheter indwelling time,hospitalization stay,stone clearance,and principal complications of operation were analyzed statistically. Results All the 42 patients were successfully treated by mini-PCNL with holmium laser with no need of percutaneous drainage or double-J stenting. No severe complications such as massive hemorrhage or adjacent organ damage occurred. No conversion to open surgery was needed during the operation. The operation time was（ 54. 8 ± 25. 1） min（ range,30- 110 min）. The intraoperative blood loss was（ 44. 5 ± 18. 5） ml（ range,20- 150 ml）. The postoperative catheter indwelling time was 3- 5 days（ average,3. 7 ± 0. 9 days）. The hospitalization stay was 3- 7 days（ average,4. 0 ± 1. 0 d）. Small residual stones were found by postoperative KUB in 4 cases,and none of them needed a special treatment. No complications such as massive hemorrhage or severe infection occurred in a 3-month follow-up in the 42 cases. Conclusions It is safe and feasible to implement the totally tubeless PCNL for the properly selected cases. The risks of postoperative complications does not increase and it is entirely possible to be a choice for a number of PCNL.