微创经皮肾镜钬激光碎石术治疗肾脏结石96例分析  

Minimally Invasive Percutaneous Nephrolithotripsy Combined with Holmium YAG Laser in the Treatment of Kidney Calculus:a Report of 96 Cases

作　　者：李刚[1] 孙浩[1] 周留正[1] 陶美满[1] 郭涛[1] 潘鹏[1] 唐爱国[1] 吴永平[1] 

机构地区：[1]江苏大学附属医院泌尿外科,镇江212001

出　　处：《中国微创外科杂志》2013年第11期1018-1020,1030,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的 探讨微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗肾脏结石的疗效和安全性.方法 2008年1月～ 2013年1月96例肾脏结石在B超引导下定位穿刺,建立F18经皮肾工作通道,通过F8.0/98输尿管硬镜找到结石,采用60 W钬激光将其击碎、取出,留置F16肾造瘘管.结果 术中因经皮肾穿刺术失败改开放手术2例（2.1％）.94例顺利完成手术,其中单通道取石85例,双通道9例;一期取石81例,二期取石13例;手术时间80 ～160 min,平均100 min;76例取净结石,结石清除率80.8％（76/94）.术中输血11例,术后输血7例,术后迟发性大出血2例,行超选择性肾动脉栓塞后治愈.18例术后结石残留,体外冲击波碎石联合药物排石治愈.平均住院11 d（9～25 d）.94例随访6～ 12个月,平均8个月,5例结石复发;术前合并肾积水65例,术后33例肾积水消失,25例肾积水较术前减轻,7例肾积水较术前无明显变化.结论 MPCNL治疗肾脏结石并发症少,手术安全性及结石清除率高,疗效满意.Objective To evaluate the efficacy and safety of minimally invasive percutaneous nephrolihotomy （ MPCNL） combined with holmium YAG laser lithotripsy in the treatment of kidney calculus.Methods From January 2008 to January 2013,96 cases of kidney calculus underwent puncture under the guidance of B ultrasonography.A percutaneous F18 working channel was made,and stones were found under F8.0/9.8 rigid ureteroscope.Then the stones were broken by 60 W holmium laser and removed.Finally,a nephrostomy tube was placed in the incision.Results Two cases were converted to open surgery due to percutaneous nephrolithotomy failure （2.1％）.The other 94 cases were performed successfully,including 85 cases of single channel and 9 cases of double channels;one-stage operation was performed in 81 cases and two-stage operation was performed in 13 cases.The operation time was 80-160 min （average,100 min）.Complete stone clearance was achieved in 76 cases with an overall clearance rate of 80.9％ （76/94）.Blood transfusion was required in 11 cases intraoperatively and 7 cases postoperatively.Two cases complicated with severe postoperative bleeding were successfully treated with blood transfusion and super-selective arterial embolization.Eighteen cases of residual renal stones were successfully managed by extracorporeal shock wave lithotripsy and medication.The average hospital stay was 11 d（range,9-25 d）.All the 94 cases were followed up for 6 to 12 months （mean,8 months）,during which 5 patients suffered from stone recurrence.For the 65 cases of preoperative hydronephrosis,hydronephrosis disappeared in 33 cases,alleviated in 25 cases,and remained in 7 cases.Conclusions MPCNL combined with holmium YAG laser lithotripsy in the treatment of kidney calculus is safe and feasible.It has less complications and higher stone clearance rate.

关 键 词：微创经皮肾镜 钬激光 肾脏结石 

分 类 号：R699[医药卫生—泌尿科学]