微造瘘经皮肾镜大功率钬激光碎石术治疗复杂性肾结石  

Minimally Invasive Percutaneous Nephrolithotomy by High-power Ho:YAG Laser Lithotripter for Complex Renal Calculi

作　　者：陈康宁[1] 王振显[1] 王刚[1] 孙福振[1] 杨涛[1] 

机构地区：[1]河北省人民医院泌尿外科,石家庄050051

出　　处：《中国微创外科杂志》2011年第11期992-994,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨微造瘘经皮肾镜大功率钬激光碎石术治疗复杂性肾结石的疗效。方法 2008年2月～2011年3月68例复杂性肾结石在B超引导下进行穿刺,以筋膜扩张器逐级扩张至F16,建立皮肾操作通道,置入F8/9输尿管硬镜,科以人100 W钬激光碎石机将结石击碎取出,常规留置F14肾造瘘管。结果 59例(86.8%)一期单通道碎石取石,其中54例一次取净结石,一次结石清除率为79.4%(54/68);余5例残留小结石配合体外震波碎石治疗后排净结石。2例中转开放手术取石,7例二期碎石或取石。手术时间105～220 min,(120.5±39.1)min;术后住院8～13 d,(10.6±2.5)d。68例随访3～36个月,(21.6±7.8)月,3例结石复发,体外震波碎石后治愈。结论微造瘘经皮肾镜下大功率钬激光碎石治疗复杂性肾结石安全、高效,对患者创伤小、出血少、恢复快、结石清除率高,是治疗肾结石安全、有效的方法。Objective To assess the efficacy of high-power holmium laser in minimally invasive percutaneous nephrolithotomy for complex renal calculi.Methods A restrospective investigation was made on 68 patients with complex renal calculi who were treated with minimally invasive percutaneous nephrolithotomy by high-power holmium laser from February 2008 to March 2011.A track from the skin surface into the renal calix was established under the guidance of B-ultrasonography in all of the cases.After dilation,a sheath F16 was passed in and then F8/9.8 rigid ureteroscopy was placed to introduce a holmium laser lithotripter.The stones were smashed and a nephrostomy tube was placed through the incision to drain the fluid from the kidney.Results Holmium laser percutaneous nephrolithotomy was completed in the first stage in 59 cases by a single tract,and stones in 54 cases were removed completely in one session;another 5 cases received ESWL after the operation.The one-session stone-free rate was 79.4%（54/68）.The second stage of treatment was achieved in 7 cases.2 cases were converted to open surgery.The mean operation time and hospital stay were（120.5±39.1） minutes（ranged from 105-220 minutes） and（10.6±2.5） days（ranged 8-13 days）.68 cases were followed up for 3 to 36 months [（26.6±7.8） months],during which 3 patients suffered from stone recurrence and were cured by ESWL.ConclusionsHigh-power holmium laser with mini-percutaneous nephrolithotomy is a safe and effective option and has advantages of minimal invasion,less blood loss,quick recovery,and high stone clearance rate for complex renal calculi.

关 键 词：经皮肾镜 肾结石 钬激光 

分 类 号：R699[医药卫生—泌尿科学]