经皮肾镜手术治疗上尿路结石100例的体会

Experience of Treating 100 Cases of Upper Urinary Tract Stones with Percutaneous Nephroscope

目的分析总结对上尿路结石患者(肾结石及输尿管上段结石)采取经皮肾镜钬激光碎石取石术(percutaneous nephrolithotomy with laser lithotripsy,PCNL)治疗体会。方法将本院2020年1月-2021年12月收治的100例上尿路结石患者作为本次回顾分析对象,所有患者均经由临床检查确诊疾病,确诊后对所有患者均采取经皮肾镜钬激光碎石取石手术治疗,分析在手术治疗后患者的临床疗效、并发症发生率。结果本次研究中,所有患者在采取经皮肾镜钬激光碎石取石手术治疗后均全部康复出院。并发症发生率结果显示:术后感染休克0%,残石率5%,因出血切肾率0%,因出血、感染导致死亡率0%,治疗总有效率100%。结论在上尿路结石患者的临床干预中对患者采取经皮肾镜钬激光碎石取石手术治疗能够有效提高患者的临床疗效。依靠B超定位借助多普勒彩色血流信号,避开大血管做到精准穿刺避免大出血,术中低压灌注,术后2h常规血常规检查有无感染迹象,做到早预防、早发现、早治疗,预防了患者手术后由于大出血、严重感染等原因出现肾切除、死亡等情况。提示经皮肾镜钬激光碎石取石手术具有微创、准确、安全等优势,手术对患者身体所造成的创伤更小,患者手术后并发症发生率较低,具有更好的安全性,值得临床广泛应用。

Objective To analyze and summarize the treatment experience of percutaneous nephrolithotomy with laser lithotripsy(PCNL)in the patients with renal stones and upper ureteral stones.Methods One hundred patients with urocalculi admitted from January 2020 to December 2021 in the review.All patients were diagnosed by clinical examination,and all patients underwent percutaneous nephroscopic holmium laser lithotripsy to analyze the clinical efficacy and complications after surgical treatment.Results In this study,all patients recovered and were discharged from the hospital after undergoing percutaneous nephroscope holmium laser lithotripsy.The results of the complication rate showed:Postoperative infectious shock 0%,residual stone rate 5%,renal resection rate due to bleeding 0%,death rate due to bleeding and infection 0%,and the total effective rate of treatment 100%.Conclusion In the clinical intervention of patients with upper urinary tract stones,percutaneous nephrolithotomy with holmium laser lithotripsy can effectively improve the clinical efficacy of patients.Relying on B-ultrasound positioning and Doppler color blood flow signals,avoiding large blood vessels to achieve precise puncture to avoid hemorrhage,intraoperative low-pressure perfusion,routine blood routine check for signs of infection 2 hours after surgery,to achieve early prevention,early detection,early treatment prevents the patient from undergoing nephrectomy and death due to hemorrhage,severe infection and other reasons after the operation.It is suggested that percutaneous nephrolithotomy with holmium laser lithotripsy has the advantages of minimal invasiveness,accuracy,and safety.The operation causes less trauma to the patient’s body,and the incidence of complications after the operation is lower.It has better safety and is worthwhile widely used clinically.