顺行输尿管软镜联合经皮肾镜治疗鹿角型肾结石

Efficacy and safety of anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy in treatment of staghorn renal calculi

目的探讨顺行输尿管软镜联合经皮肾镜治疗完全性鹿角型肾结石的安全性及有效性。方法回顾性分析2014年7月至2017年1月徐州医科大学附属徐州临床学院行顺行输尿管软镜联合经皮肾镜治疗的18例鹿角型肾结石患者。结石最大径≥3 cm。经皮肾镜碎石后探查术野无结石残留后经原肾镜鞘置入Wolf输尿管软镜,软镜逐步探查各组肾盏,钬激光粉碎残余肾盏结石,较大碎石用套石篮取出。分析手术成功率、结石清除率(SFR)、术中出血量、手术时间及术后并发症。结果 15例患者一期完成手术,10例术后复查结石清除完全(66.7%),5例结石残留,术后结合体外冲击波碎石成功排出结石,2例患者因经皮肾镜术中出血明显,未联合软镜碎石,1例因肾积脓留置肾造瘘管后二期碎石。术中出血量(210.0±50.0)ml,手术时间(65.0±20.5)min。术后5例患者出现发热,常规治疗后缓解,1例寒战高热,加强抗感染后痊愈。1例患者术后并发假性肾动脉瘤,行介入栓塞后治愈,其余患者术后未出现严重出血,肾造瘘管留置5~7 d拔除。结论顺行输尿管软镜联合经皮肾镜可一期治疗鹿角型肾结石,术后残石率低,并发症少,是治疗鹿角型肾结石的有效手术方案。

Objective To assess the safety and efficacy of anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy in the treatment of complete staghorn renal calculi.Methods A retrospective analysis was performed of18patiets with complete staghorn renal calculi who were treated by anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy in Affiliated Xuzhou Clinical College of Xuzhou Medical University from July2014to January2017.After percutaneous nephrolithotomy,there was no residual stones in the field.Then flexible ureteroscopy was used to investigate all renal calyces,and the residual renal calculi were treated with holmium laser.The success rate of operation,stone clearance rate,intraoperative blood loss,operative time,and postoperative complications were analyzed.Results Fifteen patients had a complete surgery;there were no residual stones in10(66.7%)cases postoperatively,and shock wave lithotripsy successfully discharged calculi in five cases who had a small amount of residual stones.Flexible ureteroscopy was not applied in two patients because of obvious bleeding during percutaneous nephrolithotomy.One patient underwent nephrostomy because of pyonephrosis.Estimated intraoperative blood loss was(210.0±50.0)ml,and operative time was(65.0±20.5)min.Fever occurred in five patients,which relieved after routine treatment.One patients developed fever chills,which was cured after strengthened anti-infection treatment.One patient developed renal artery aneurysm and was managed by interventional embolization.The remaining patients did not develop serious bleeding,and stoma drainage catheters were removed in5-7days.Conclusion Anterograde flexible ureteroscopy combined with percutaneous nephrolithotomy is an effective treatment for complete staghorn renal calculi.