标准经皮肾镜联合膀胱软镜铥激光治疗复杂肾结石疗效分析

Efficacy and Safety of Combined Application of Flexible Cystoscopy and Thulium Laser in Standard Percutaneous Nephrolithotomy for Complex Renal Calculi

目的总结标准经皮肾镜联合膀胱软镜铥激光治疗复杂肾结石的疗效、安全性,探讨其临床应用价值。方法回顾性分析2011年9月至2015年5月,接受标准经皮肾镜联合膀胱软镜铥激光碎石治疗复杂肾结石患者91例的临床资料,采用超声引导下建立F22标准经皮肾镜通道后,使用第四代EMS超声/气压弹道碎石系统清除视野内结石。术后更换电子膀胱软镜,检查各盏内结石残留情况,铥激光碎石并将残渣冲出。术后复查泌尿系平片评估碎石效果。术后3 d复查KUB,以结石>4 mm为有临床意义残留。术后第2个月复查肾功能,随访8~24个月结果 91例患者均碎石成功,无术中、术后严重并发症发生。手术时间40~110 min,平均55.3 min。术后留置肾造瘘管4~5d,双J管保留4~8周。复查泌尿系平片,结石完全清除率89.0%(81/91),总清石率94.5%(残石≤4 mm,不需特殊处理5例),5例患者结石残留0.5~0.9 cm,给予体外冲击波碎石结合排石药物口服治疗,均未能完全排石。随访8~24个月,平均15.60个月,无肾功能受损患者。结论标准经皮肾镜联合膀胱软镜铥激光治疗复杂肾结石具有清石率高、微创、安全的优势,疗效确切、持久的优点。

Objective To evaluate the clinical efficacy and safety of thulium laser with flexible cystoscopy in standard percutaneous nephrolithotomy for the treatment of complex renal calculi.Methods A review study was conducted on 91 patients of complex renal calculi that had been given thulium laser therapy with flexible cystoscopy in standard percutaneous nephrolithotomy from Sep.2011 to May 2015.The data of them were collected preoperatively.A F22 standard PCNL surgical channel was established,the fourth-generation EMS stone clearance system was applied,and flexible cystoscopy was used to remove the residual stones with thulium laser.The complications of the operation,outcome and recurrence rate were observed,and a follow-up for 8-24 months was conducted.ResultsAll the operations were successful.No serious complication occurred during and after the operations.No massive hemorrhage,adjacent organ or other complications appeared.The average operation time was 40-110 min,the time of D-J indwelling was 4-8weeks and the time of nephrostomy tube indwelling was 4-5 days.The complete clearance of stone was 89.01%（81/91）and the total stone clearance was 94.5%.At the average follow-up of 8 to 24 months,no patient was found with impairment of renal functions.Conclusions Combined application of sandard percutaneous nephrolithotomy and flexible cystoscopy is safe and effective in treating complex renal calculi.