逆行输尿管软镜联合可视微通道经皮肾镜一期治疗鹿角形肾结石的临床分析  

Retrograde flexible ureteroscopy combined with visual minimally channel percutaneous nephrolithotomy in the treatment of staghorn calculi

作　　者：程跃[1] 谢国海[1] 严泽军[1] 袁鹤胜[1] 方立[1] 胡嘉盛[1] 郑重[1] 

机构地区：[1]宁波大学医学院附属宁波市第一医院泌尿外科,315010

出　　处：《中华泌尿外科杂志》2016年第2期127-130,共4页Chinese Journal of Urology

基　　金：宁波市社会发展项目（2011C50065）

摘　　要：目的：探讨逆行输尿管软镜联合可视微通道经皮肾镜一期治疗鹿角形肾结石的安全性和有效性。方法回顾性分析2015年1—6月我院23例采用逆行输尿管软镜联合可视微通道经皮肾镜一期治疗鹿角形肾结石患者的资料。男14例，女9例，年龄26-79岁，平均39．6岁。结石直径3．5-6．5 cm，平均（5．35±0．16）cm。全身麻醉或腰硬联合麻醉下，先通过经皮肾镜以常规方法处理视野范围内的结石，然后用逆行输尿管软镜处理上、下盏及皮肾通道平行盏结石。术毕常规留置F5／F6号双J管和肾造瘘管。术后第1天复查KUB和CT，如有＞4mm的结石碎片，则1周后二期软镜和／或经皮肾镜处理。4周后复查B超或CT，评估结石排净率。残留结石≥4mm为有意义的结石残留。结果所有病例均顺利完成手术。一期无石率为91．3％（21／23），二期无石率为100％（23／23）。一期手术时间75-217 min，平均（125±13．2）min。7例发生轻度并发症（Clavien分级Ⅰ－Ⅱ级），无Ⅲ级及以上并发症发生。结论逆行输尿管软镜联合可视微通道经皮肾镜一期治疗鹿角形肾结石是安全、有效的。Objective To evaluate the safety and efficacy of retrograde flexible ureteroscopy combined with visual minimally channel percutaneous nephrolithotomy （ mPCNL） in the treatment of staghorn calculi.Methods A total of 23 patients with staghorn calculi were treated by retrograde flexible ureteroscopy combined with visual mPCNL from January to June, 2015.Of all the 23 patients, 20 were males and 10 were females （ ages ranged from 26 years to 79 years ） with mean age of 39.6 years.The calculi ranged from 3.5 cm to 6.5 cm [average （5.35 ±0.16） cm].Under general anesthesia or epidural anesthesia, the stones were shattered within the visual field through mPCNL firstly, then the stones in upper calyx, lower calyx and/or calyx which parallel with the percutaneous renal access were shattered by retrograde flexible ureteroscopy.F5 or F6 double-J tubes and nephrostomy tubes were routinely indwelled postoperatively.KUB and CT were performed at the first day postoperatively.A second-stage retrograde flexible ureteroscopy combined with visual mPCNL were performed for patients with residual stone fragments larger than 4 mm at the first week follow-up.Re-examinations with B-ultrasonography or CT was performed at the fourth week follow-up postoperatively to evaluate the stone free rate.Residual stones ≥ 4 mm were considered as clinical significance of residual stone.Results All the procedures were successful.The stone free rate was 91.3%（21/23） at one-stage and 100% （23/23） after the second stage.The operation time was 75-217 min [average （125 ±13.2） min] for one-stage procedure.Seven patients experienced with mild complications （ Clavien-Dindo classification： gradeⅠ-Ⅱ） , and no patient experienced grade Ⅲ or above complications.Conclusions Retrograde flexible ureteroscopy combined with visual mPCNL are safe and effective for the treatment of staghorn calculi.

关 键 词：鹿角形肾结石 可视微通道经皮肾镜 输尿管软镜 联合治疗 

分 类 号：R699.2[医药卫生—泌尿科学]