单通道经皮肾镜取石术结合输尿管软镜治疗鹿角状肾结石  

Treatment of staghorn calculi under single-channel percutaneous nephrostolithotomy combined with flexible ureteroscopy

作　　者：赵春明[1] 米其武[1] 王卫峰[1] 张若愚[1] 孟祥军[1] 张志刚[1] 张增强[1] 李牧[1] 

机构地区：[1]广东省东莞市人民医院泌尿外科

出　　处：《临床泌尿外科杂志》2008年第2期111-112,共2页Journal of Clinical Urology

摘　　要：目的:探讨单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石的手术效果。方法:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石96例。结石大小2.9cm×3.4cm～3.8cm×5.5cm,平均3.5cm×4.2cm。结果:96例均采用单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石,一期手术平均手术时间为118min;结石清除率为82.3%(79/96),二期手术平均手术时间为55min,结石总清除率92.7%(89/96)。7例患者残留结石,大小0.3～1.0cm,其中5例术后1个月接受ES-WL治疗。术后随访7例残留结石患者2～6个月,结石清除5例。结论:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石具有手术时间短、结石清除率高、创伤小、并发症少、周围脏器损伤风险小等优点,可作为鹿角状肾结石的治疗方法。Objective ： To evaluate the efficacy of single channel percutaneous nephrostolithotomy（PCNL） combined with flexible ureteroscopic lithotripsy using holmium laser in patients with renal staghorn calculi. Methods： 96 cases of renal staghorn calculi including 52 males and 44 females were selected to be treated by single-channel PCNL combined with flexible ureteroscopic lithotripsy using holmium laser. The age of the patients was 23 to 67, 50 years old on average ; the size of calculi was 2.9 cm× 3.4 cm- 3.8 cm × 5.5 cm, 3.5 cm × 4.2 cm on average. Results：82.3% （79/96） of patients treated by single channel PCNL combined with flexible ureteroscopic lithotripsy using holmium laser were healed in the first stage of the operation. The average operation time of the first stage was 118 rain. but 17 patients were healed in the second stage of the operation. The average operation time of the second stage was 55 rain and the clearance rate reached 92.7% （89/96）. Seven cases had several residual calculi from 0. 3 cm to 1.0 cm, 5 cases had ESWL 1 month postoperatively. Seven cases had a follow-up for 2 - 6 months,5 cases were stone-free. Conclusions： Single-channel PCNL combined with flexible ureteroscopic lithotripsy using holmium laser has good therapeutic effect in treating renal staghorn calculi since the technique in treating the renal staghorn calculi makes the operation period shorter, the rate of stone-free higher, the operation wounds smaller ,the rate of complication lower , the rate of surrounding organ injury less.

关 键 词：肾结石 经皮肾镜 气压弹道碎石 输尿管软镜 钬激光 

分 类 号：R692.4[医药卫生—泌尿科学]