经皮肾镜钬激光治疗257例肾结石的回顾性分析

Percutaneous nephrolithotomy with holmium laser in the treatment of 257 cases of renal calculi:A retrospective study

目的对经皮肾镜钬激光治疗的肾结石患者的治疗效果进行回顾性分析,以期为临床治疗提供依据。方法择取笔者所在科在2010年8月—2013年8月间收治的257例肾结石患者,并对全部患者实施经皮肾镜钬激光治疗。治疗后评估结石清除率,随访4个月观察结石排出情况。结果 257例中213例行一期结石清除,一期结石清除率为82.88%,36例患者行二期结石清除,二期结石清除率为14.01%,合计结石清除率96.89%;8例患者无法耐受二期手术,一期手术7 d后行体外冲击波碎石术进行治疗,均将残余结石清除。257例患者在手术过程及术后均未出现明显的大出血及其他的不良反应。结论经皮肾镜钬激光手术治疗肾结石的效果是理想的,对于大的复杂肾结石或较大的鹿角形肾结石先行一期手术再根据残留结石和患者身体情况决定是否行二期手术或行体外冲击波碎石术。

Objective The patients treated with percutaneous nephrolithotomy holmium laser lithotripsy were retrospectively analyzed for the treatment effects,so as to provide the basis of clinical application. Methods The 257 cases of renal calculi were selected in 2010 August to 2013 August in author’s department were treated with percutaneous nephrolithotomy with holmium laser. After the treatment of renal calculi clearance rate was evaluated,and followed up for 4 months to observe the stone expulsion. Results Among the 257 cases,213 received primary stone clearance,the stone clearance rate was 82.88%;36 underwent secondary stone clearance,the stone clearance rate was 14.01%,thus the total stone clearance rate was 96.89%;8 patients were unable to tolerate the secondary operation,7 days after the first operation also received extracorporeal shock wave lithotripsy(ESWL) in the treatment of residual stones,finally would be cleared. Conclusion It is ideal for the implementation of percutaneous nephrolithotomy with holmium laser in treatment effect. And it should be chosen to perform secondary operation or to take ESWL according to the patient ’s condition following minimally invasive surgery first for the bigger complex or staghorn calculi.