Ⅰ期单通道经皮肾镜联合输尿管软镜钬激光治疗复杂性肾结石的效果观察

Effect of Stage Ⅰ single-channel percutaneous nephroscopy combined with flexible ureteroscope holmium laser in the treatment of complex renal calculi

目的了解I期单通道经皮肾镜联合输尿管软镜下钬激光碎石术治疗复杂性肾结石的可行性和安全性。方法选取28例复杂性肾结石患者,留置患侧D-J管2周后,行单通道经皮肾镜联合输尿管软镜钬激光I期碎石术,术后留置D-J管及肾造瘘管。分析手术时间、出血量、术后并发症、住院时间以及结石清除率,术后结石≥0.4 cm认定为结石残留,行Ⅱ期手术治疗。结果所有患者均顺利完成手术,无术中改开放手术,无大出血、感染性休克等重大并发症,Ⅰ期手术23例,Ⅱ期手术5例,Ⅰ期结石清除率为82.1%(23/28),Ⅱ期结石清除率为100.0%,Ⅰ期手术时间(77.39±19.99) min,估计失血量(132.32±47.97) mL,术后(4.60±0.63) d拔除肾造瘘管,术后住院时间(8.25±2.70) d。结论Ⅰ期单通道经皮肾镜联合输尿管软镜钬激光治疗复杂性肾结石手术方式有效、安全。

Objective To investigate the feasibility and safety of Stage I single-channel percutaneous nephroscopy combined with flexible ureteroscopic holmium laser in the treatment of complicated renal calculus.Methods 28 patients with complicated renal calculus admitted were selected for single-channel percutaneous nephroscope combined with flexible ureteroscopic holmium laser Stage I lithotripsy after 2 weeks of the D-J tube retention on the affected side,and the D-J tube and renal fistula were retained postoperatively.The operation time,amount of bleeding,postoperative complications,hospital stay and stone clearance rate were analyzed.The postoperative stone ≥0.4 cm was identified as stone residue,and the Stage Ⅱ operation was then performed.Results All patients had a successfully operation and had no change to open surgery during the operation and no major complication such as massive hemorrhage and infectious shock.23 cases received the Stage Ⅰ operation while 5 cases received the Stage Ⅱ operation.The stone clearance rate in Stage I operation was 82.1% while that in Stage Ⅱ operation was 100.0%.In the Stage Ⅰ operation,the operation time was (77.39±19.99) min,EBL was (132.32± 47.97) mL,the renal fistula was removed on (4.60±0.63) d after operation,and the postoperative hospital stay was (8.25± 2.70) d.Conclusion Stage I single channel percutaneous nephroscope combined with flexible ureteroscopic holmium laser is effec-tive and safe for the treatment of complicated renal calculi.