腹腔镜肾盂切开联合肾镜取石术治疗肾多发性结石  

Laparoscopic pelvilithotomy combined with percutaneous nephrolithotomy surgery treatment in multiple renal calculi

作　　者：梁卓寅[1] 单志昌[1] 陈琇萌[1] 

机构地区：[1]广州医学院第一附属医院微创外科中心泌尿外科,510230

出　　处：《中国综合临床》2010年第11期1209-1210,共2页Clinical Medicine of China

摘　　要：目的 探讨腹腔镜肾盂切开联合肾镜取石术治疗肾多发性结石的技术要点和初步经验.方法 选取我院2008年1月至2009年12月腹腔镜肾盂切开合并肾镜取石术治疗肾多发性结石患者8例.全部经腹膜后途径入路.结石最大3.3 cm×2.3 cm,最小0.5 cm×0.5 cm.均为肾盂铸型结石合并肾盏多发小结石.先用腹腔镜取出肾盂结石.若是铸型结石取出较难,则通过肾盂切开处放入肾镜,弹道碎石器击碎结石后再取出.然后肾镜继续探查各肾盏,并取出结石.结果 8例肾多发结石患者结石全部取尽,手术效果满意.手术时间平均90 min.均未出现出血、尿漏、输尿管狭窄等严重并发症.术后平均住院时间5 d.结论 腹腔镜肾盂切开联合肾镜取石术取两种手术的优点,减少并发症的发生,可获得最大的疗效.Objective To study the key points and preliminary experience in the application of laparoscopic pelvilithotomy combined with percutaneous nephrolithotomy（PCNL）surgery in multiple renal calculi. Methods Eight patients,accepted laparoscopic pelvilithotomy combined with PCNL surgery in our hospital from January 2008to December 2009,were enrolled into the study. Retroperitoneal approach were performed in all operations. The biggest stone was 3.3 cm ×2.3 cm,the smallest one was 0.5 cm ×0.5 cm. All patients had renal pelvis cast stone along with multiple small renal calyceal stones. The stones were removed under laparoscopic operation at the first step. If it was difficult to remove the pelvis cast stone,nephroscope were settled into the pelvis through incision,and then the shattered stone smashed by lithotripsy were removed under the observation of nephroscope. Further exploration and removal of the remaining stones in every calices was necessary for the patients. Results The operations were successful in all cases and all stones were removed thoroughly and get satisfactory effects. The average operation time was 90 minutes. No serious complications happened,such as bleeding,urine leakage or ureteral stricture. The average length of hospital stay was 5 days. Conclusions Our treatment combines the advantages of both laparoscopic pelvilithotomy and percutaneous nephrolithotomy to reduce the incidence of complications and improve the therapeutic effects.

关 键 词：腹腔镜 肾盂切开取石术 经皮肾镜取石术 

分 类 号：R699.2[医药卫生—泌尿科学]