电子输尿管软镜钬激光碎石治疗一期单通道经皮肾镜术后残石的安全性及疗效  

Efficacy and safety of digital flexible ureteroscope combined with holmium laser lithotripsy for residual calculi after one stage single-tract percutaneous nephrolithotomy

作　　者：徐刚[1] 李忠义[1] 张哲伟[1] 张勇[1] 陈继民[1] 杜传军[1] 

机构地区：[1]浙江大学医学院附属第二医院泌尿外科,杭州310000

出　　处：《中华腔镜泌尿外科杂志（电子版）》2014年第3期23-26,共4页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的总结电子输尿管软镜钬激光碎石治疗一期单通道经皮肾镜取石术（PCNL）术后残石的安全性及疗效。方法回顾性分析我院2010年5月至2012年12月期间，使用电子软性输尿管镜钬激光碎石术处理一期单通道经皮肾镜取石术后残石41例，男22例，女19例，平均年龄（44±12）岁。术前结石均为复杂性鹿角形肾结石，术后残石3例位于上盏，6例结石位于中盏，7例位于下盏，25例为多个肾盏残石，单枚结石9例，结石直径15～25mm；其余均为多枚结石，结石直径4-25mm。再次手术时间为PCNL术后1-4周，软性输尿管镜碎石前，造瘘管已拔除23例，仍保留肾造瘘管18例。结果41例患者均顺利地置入电子输尿管软镜，平均手术时间（83±31）min，术后平均住院时间（3-1）d。均无肾盂输尿管严重损伤、大出血、急性肾功能不全、感染性休克等并发症。术后3个月复查超声或CT提示，有意义结石残留（≥4mm）5例：2例为下盏残石，3例为多盏残石。中上盏碎石成功率100％（9／9），下盏为85．7％（6／7），多盏为84．0％（21／25）。保留肾造瘘管及拔除肾造瘘管患者再次手术时间、术后住院时间、结石清除率及术后发热均无显著性差异。结论在一期单通道PCNL减轻肾结石负荷的情况下，电子输尿管软镜下钬激光碎石能有效清除残余结石，并发症少，可选择性地作为单通道一期PCNL术后残留结石的治疗。Objoetive To investigate the efficacy and safety of digital flexible ureteroscope combined with holmium laser lithotripsy for residual calculi after one stage single-tract percutaneous nephrolithotomy （PCNL）. Mothoda From May 2010 to December 2012, 41 cases （22 males and 19 females with mean age of 44 years） of staghorn renal calculi treated with one stage singletract access PCNL and second stage operation of holmium laser lithotripsy with flexible ureteroscope were reviewed. After PCNL, the residual calculi were evaluated. Three cases had fragments located in the upper calyx, 6 in the middle calyx,7 in the lower calyx, and the remaining 25 cases in multiple calyxes. Of the 41 cases, the residual stone was single in 9 cases with diameter from 15 to 25 mm and multiple in the other 32 cases with diameter from 4 to 25 mm. The interval between two procedures ranged from 1 to 4 weeks. 18 cases still kept the nephrostomy tube, while 23 were removed before the operation of flexible ureteroscope combined with holmium laser lithotripsy. Resulta The mean operation time was 83 min （30-155 min）, the mean length of postoperative hospital stay was 3 days. No major complications occurred. The stone free rate （SFR） was 87.8%（36/41）. 2 cases had residual fragment （ ≥4 mm） in the lower calyx,and 3 in multiple calyxes. The SFR was 100% （9/9）while dealing with upper and middle calyx residual calculi, 85.7% （6/7）with lower calyx residual calculi, and 84.0% （21/25）with multiple calyxes residual calculi. However, there were no statistically significant differences between the two groups of patients with or without nephrostomy tube in the parameters of operation time, length of postoperative hospital stay, stone-free rate and complications. Conelusitms Digital flexible ureteroscope combined with holmium laser lithotripsy is a safe, feasible and effective method for residual calculi after one stage singletract PCNL, reducing potential morbidity associated with multiple tracts. It should be attempted

关 键 词：肾结石 经皮肾镜 输尿管软镜 

分 类 号：R699[医药卫生—泌尿科学]