输尿管软镜钬激光碎石术治疗PCNL术后残石的临床观察  

Treatment for residual stone after PCNL with flexible ureteroscopy and holmium laser lithotripsy

作　　者：陈文忠[1] 钟文 曾国华 吴文起 

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,广州440100 [2]广东省泌尿外科重点实验室

出　　处：《临床泌尿外科杂志》2013年第3期172-173,176,共3页Journal of Clinical Urology

摘　　要：目的:总结输尿管软镜结合钬激光碎石术治疗PCNL术后残石的疗效,探讨肾脏残石的处理技巧。方法:对38例PCNL术后部分结石残留患者先取截石位,逆行输尿管软镜钬激光碎石术,并使用网篮将碎石取至肾盂;再转俯卧位,二期行PCNL从原通道中清理肾内碎石屑。结果:38例患者碎石顺利,平均结石清除率达82%,手术时长45～65min,平均52min。术后6例患者出现发热,无患者需输血及其他严重并发症。术后1个月拔除内支架。2周后复查KUB,结石清除率达89.1%。结论:输尿管软镜钬激光碎石是处理肾脏残石的有效手段,即便硬镜难以观察到的肾脏残石"盲区",也可从原造瘘管处理,同时避免了多通道、多期取石带来的风险,是处理残石的一种安全方法。Objective：To summarize the efficiancy of treatment for residual stone after PCNL with flexible ure teroseopy and holmium laser lithotripsy, and report the technique for it. Methods： 38 cases with residual stones after PCNI. received treatment, firstly with flexible ureteroseopy and holmium laser lithotripsy in lithotomy position, and stone fragments was remoed to renal pelvis using the basket, then took out by second stage PCNL from the original channe. Results： 38 patients were successfully treated, the stone free rate was 82G, mean operation time was 52 min （45-65 min）. 6 cases with postoperative fever, no patient required blood transfusion, no other serious complication was noted. Stent was removed 1 month postoperatively, and the stone clearance rate was 89. 1G two weeks later on KUB. Conclusions： Flexible ureteroscopy with holmium laser litbotripsy is an effective means for treatment of residue stone following PCNL, even renal residual stone can not be seen form PCNL, while avoiding the multi--channel and session for PCNL.

关 键 词：肾结石 输尿管软镜 钬激光 

分 类 号：R691.4[医药卫生—泌尿科学]