单通道微创经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的临床研究

Clinical Study on Application of Combination of Single Channel Minimally Invasive Percutaneous Renal Endoscopy and Flexible Ureteroscope in Treatment of Complicated Renal Calculi in the Same Stage and in Different Stages

目的 对比分析单通道微创经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的可行性及临床效果.方法 选取2012年10月～2015年10月我科诊治的复杂性肾结石患者37例,对其资料进行回顾性分析,其中完全铸形肾结石、鹿角状肾结石25例,不完全铸形、多发结石12例,结石直径25～43 mm,给予单通道微创经皮肾镜联合输尿管软镜同期或分期治疗,37例患者中行同期手术25例,分期手术12例,比较两组手术时间及结石清除率.结果 两组患者术后均未出现大出血、肠道损伤及严重感染等并发症.同期组结石清除率与分期组相当,差异无统计学意义（X^2=4.92,P〉0.05）.结论 单通道微创经皮肾镜联合输尿管软镜治疗复杂性肾结石安全有效,值得进一步推广,应根据患者术前检查及术中情况决定行同期或分期手术.

Objective To observe the feasibility and clinical effect of application of combination of singlechannel minimally invasive percutaneous renal endoscopy and flexible ureteroscope in treatment ofcomplicated renal calculi in the same stage and in different stages. Methods The data of 37 complicatedrenal calculi patients who were treated in the department from October 2012 to October 2015 wereretrospectively analyzed. Among all the patients, there were 25 cases of complete casting kidney stonesand staghorn calculi and 12 cases of incomplete casting and multiple stones with the diameter rangingfrom 25～43 mm. All the patients were treated with the application of combination of single channelminimally invasive percutaneous renal endoscopy and flexible ureter in the same stage and in differentstages. Among 37 patients, 25 cases accepted operations in the same stage and 12 cases underwentoperations in different stages so as to compare the operation time and stone clearance rate of two groups.Result No major bleeding, intestinal injury and severe infection occurred in the two groups. The stoneclearance rates of Same Stage Group and Different Stages Group were similar, without statisticallysignificant difference （c2=4.92, P〉0.05）. Conclusion The application of combination of single channelminimally invasive percutaneous nephrolithotomy and flexible ureteroscope was safe and effective inthe treatment of complicated renal calculi, which was worthy of further promotion. Complicated renalcalculi patients should be treated by surgeries in the same stage or in different stages according to thepreoperational examinations and intraoperational conditions.