不同体位多镜联合治疗复杂性肾结石  

The treatment of complicated renal calculus by multiplex endoscopy under different positions

作　　者：郭环宇[1] 赵谦[1] 席兰[1] 宋飞[1] 韩增箎[1] 黄伟[1] 侯飓[1] 邵建国[1] 

机构地区：[1]山东中医药大学第二附属医院泌尿外科,山东济南250001

出　　处：《现代泌尿外科杂志》2014年第1期33-35,共3页Journal of Modern Urology

摘　　要：目的 探讨针对不同患者选择合适体位联合多种内腔镜治疗复杂性肾结石的安全性及疗效。方法 对在2011年7月至2013年1月选择适合体位联合多种内腔镜进行治疗的78例复杂性肾结石患者资料进行回顾性分析。男51例，女27例，平均年龄49（26-73）岁，肾鹿角形结石47例，多发肾盂、肾盏结石31例。其中孤立肾结石3例（左侧2例，右侧1例），合并肾盂输尿管连接部（UPJ）狭窄3例，合并同侧输尿管结石13例，合并对侧输尿管结石6例，合并双侧输尿管结石4例，同侧肾切开取石术后复发6例，合并肾功能不全3例。选择俯卧位57例，向健侧倾斜45°的仰卧位8例，斜仰卧截石位13例。所有患者均联合应用多种内腔镜进行碎石、取石治疗。结果 该组78例患者肾穿刺通道均一次成功建立，未出现大出血、气胸、严重感染等并发症。肾结石一期清除率86.7%，输尿管结石清除率100%。5例残留肾结石经原经皮肾通道二次取石，3例术后配合体外冲击波碎石治疗,2例行二期经皮肾镜取石术（PCNL）。手术时间70-120 min，平均85 min;住院时间平均76 d。结论 针对不同患者选择适合体位联合多种内腔镜治疗复杂性肾结石，安全、高效，能明显减少二次麻醉及手术的几率，值得推广应用。Objective To investigate the safety and efficacy of treating complicated renal calculus by multiplex endoscopy under different positions. Methods Clinical data of 78 case of complicated renal calculus treated during July 2011 to Jan. 2013 were retrospectively analyzed. The cases included 47 staghorn calculus, and 31 multiple calculus of renal pelvis and calyce. Only 3 patients had solitary kidney stones. Of the other patients, 3 were complicated with stricture of UPJ, 13 with the homonymy ureteral calculus, 6 with the opposite ureteral calculus, 4 with two sided ureteral calculus, 6 with recrudescent renal calculus after nephrolithotomy, and 3 with renal insufficiency. 57 chose prone position, 8 contralateral prone with waist rising 45o, and 13 semisupine lithotomy position. All patients were treated by multiplex endoscopy. Results The percutaneous renal access was successfully established in all patients. No serious complications such as hematorrhea, pneumatothorax and severe infection occurred. The clearance rate of renal calculus and ureteral calculus was 86.7% and 100%, respectively. 10 cases had residual renal calculus, of which 5 were treated with ureteroscope through the first renal access, 3 with ESWL and 2 received a second PCNL. The average operation time was 85 minutes. The average hospitalization time was 7.6 days. Conclusion Treatment of complicated renal calculus by multiplex endoscopy under appropriate position has high calculus clearance rate. It can reduce the rate of a second anaesthesia and operation; therefore, it is worthy of wide clinical application.

关 键 词：腔内泌尿外科 内腔镜 肾结石 治疗 

分 类 号：R694[医药卫生—泌尿科学]