超微经皮肾镜联合摩西钬激光治疗上尿路结石的疗效

The clinical efficacy of super mini-percutaneous nephrolithotomy combined with Moses technology holmium laser in the treatment of upper urinary tract lithiasis

目的 探讨超微通道经皮肾镜碎石取石术(SMP)联合摩西技术(Moses?technology,MT)钬激光治疗上尿路结石的临床疗效及使用体会。方法 回顾性分析2019年3月至2020年6月B超引导下SMP联合MT钬激光治疗直径1-3 cm上尿路结石34例,对住院时间、手术时间、血红蛋白下降程度、手术并发症、结石清除率、无管化人数等临床资料进行分析。结果 34例均采用一期单通道超微经皮肾镜联合摩西钬激光碎石取石术。手术时间18~70 min,平均(34.5±11.6)min;术后住院天数3~7d,平均(4.4±0.7)d;血红蛋白下降5~14 g/L,平均(10.1±2.5)g/L,未留置肾造瘘管(26/34),术后第1天评估结石清除率为91.2%(31/34),术后1个月评估结石清除率为94.1%(32/34),完全无管化8人,无留置肾造瘘管11人。1例术后发热,1例出现肾周血肿合并发热,均予以抗炎对症治疗后治愈,其余患者无严重出血、尿外渗、血气胸、脏器损伤等并发症发生,无输血病例。结论 超微通道经皮肾镜碎石取石术(SMP)联合摩西技术(MT)钬激光治疗上尿路结石效果明确,结石清除率高,提高碎石效率,缩短手术时间,更加微创,值得的推广。

Objective To explore the clinical efficacy of super mini-percutaneous nephrolithotomy(SMP)combined with Moses technology(MT)holmium laser in the treatment of upper urinary tract lithiasis. Methods 34 cases of upper urinary tract lithiasis sized1-3cm treated with SMP and MT holmium laser under the guidance of B-ultrasound-guided from March 2019 to June 2020 were retrospectively analyzed. The clinical data such as length of hospital stay, operation time, degree of hemoglobin decline, surgical complications, stone clearance rate, and the number of tubeless patients were analyzed retrospectively. Results TAll 34 patients were treated with one-stage, single-channel SMP combined with Moses holmium laser lithotripsy and enucleation. The operation time was18-70 minutes, with an average of 34.5±11.6 minutes. The postoperative hospital stay was 3-7 days, with an average of 4.4±0.7 days;hemoglobin decreased by 5-14g/L, with an average of 10. 1±2.5g/L. There was no nephrostomy tube in 26 cases of 34 patients. The stone clearance rate was 91.2%(31/34)on the first day after operation, and 94.1%(32/34)one month after operation. There were 8 cases without tube and 11 patients without nephrostomy tube. One case had postoperative fever and one case had perinephric hematoma with fever, both of which cured with anti-inflammatory and symptomatic treatment. The other patients had no complications such as severe hemorrhage, urinary extravasation, pneumohemothorax, or organ injury, and there were no blood transfusion cases. Conclusion SMP combined with MT holmium laser in the treatment of upper urinary tract stones has clear effect, high stone clearance rate, improved lithotripsy efficiency, shortened operation time and more minimally invasive, so it is worthy of popularization.