截石斜仰卧位经皮肾镜联合逆行输尿管软镜二期钬激光碎石治疗鹿角形肾结石

Percutaneous nephrolithotomy combined with flexible ureteroscope holmium laser lithotripsy in the second stage operation for treatment of renal stafhorn calculi

目的评价截石斜仰卧位经皮肾镜联合逆行输尿管软镜二期钬激光碎石作为鹿角形肾结石治疗手段的效果和可行性。方法本研究为回顾性分析,连续纳入2014年1月—2018年7月浙江大学医学院附属第四医院收治的鹿角形结石患者,一期使用皮肾镜取石的方法,二期使用截石斜仰卧位经皮肾镜联合逆行输尿管软镜钬激光碎石取石的方法。术后评价患者清石率及围手术期并发症。结果本组47例患者(男30例),平均年龄(54±12)岁,均成功建立工作通道并一期碎石取石,所有患者均行二期手术。二期手术后44例患者(93.6%)结石完全清除。一期手术时间平均(61±22)min,二期手术时间平均(90±17)min。所有手术病例术后均未出现严重并发症。结论一期单通道经皮肾镜取石术、二期截石斜仰卧位下联合逆行输尿管软镜碎石取石术对于鹿角行结石的治疗效果显著且可行,多数病人可于两次手术之后达到清石效果。

Objective To evaluate the efficacy and safety of single channel percutanous nephrolithotomy(PCNL)combined with flexible ureteroscopic lithotripsy in managing renal staghorn calculi by a two-stage operation using holmium laser.Methods In this retrospective study,47 staghorn calculi patients were collected continuously from January 2014 to July 2018.At the first stage,all patients underwent single channel PCNL though a Fr22 tract within a stipulated time(120 min).The second stage operation combined PCNL with flexible ureteroscopic lithotripsy were given in a oblique supine position.After the two-stage operation,stone clearance rate and the surgical complications were evaluated.Results Totally 47 patients(30 males),average age(54±12),were given the two-stage operation using holmium laser.All operations were successful and no significant complications were found.The average operation time of the first and second stage operation were(61±22)min and(90±17)min respectively.The stone clearance rate was 93.6%after the two-stage operation.Conclusion For patients with renal staghorn calculi,a two stage operation combined PCNL with flexible ureteroscopic lithotripsy using holmium laser were safe and effective.