超微经皮肾镜取石术治疗临床有意义残石的疗效观察  

Treatment of significant residual fragments with super-micro percutaneous nephrolithotomy

作　　者：孙红红[1] 王小波[1] 王亚申 焦微红 罗飞[1] 苏彦慧[1] 李健[1] 

机构地区：[1]天津医科大学研究生院,天津市人民医院泌尿外科,天津300121

出　　处：《现代泌尿外科杂志》2016年第4期295-297,共3页Journal of Modern Urology

摘　　要：目的探讨超微经皮肾镜取石术（super-micro-PCNL,SMP）治疗临床有意义残石的可行性及安全性,初步总结肾脏残石的处理技巧。方法 SMP技术采用外径F7的超细肾镜,通过F10带吸引功能的Peel-away鞘,联合钬激光或气压弹道击碎结石,碎石屑经带吸引功能的Peel-away鞘吸到碎石收集瓶中。2011年5月~2015年7月采用SMP治疗的38例多次输尿管软镜及ESWL术后残石患者,残石位于下盏、中盏、肾盂合并下盏、肾盂合并输尿管上段分别为27、3、5、3例。结石直径平均（1.3±0.6）cm。结果 38例患者均穿刺成功,单通道35例,双通道3例,平均手术时间（37±12）min,术后第一天结石清除率为94.7%（36/38）,其中1例患者输尿管上段石街形成,需再次输尿管镜钬激光碎石术,1例下盏残留结石直径约0.6cm,二期SMP取石,4周后复查KUB,均未见结石残留。术后无气胸、尿外渗、严重感染、出血等并发症。结论 SMP治疗临床有意义残石安全有效,尤其适用于输尿管软镜及ESWL术后残石的补救性处理措施。Objective To investigate the feasibility and safety of super-micro percutaneous nephrolithotomy（SMP）in the treatment of clinically significant residual stones.Methods A total of 38 cases with clinically significant residual stones after several retrograde intrarenal surgery（RIRS）and extracorporeal shock wave lithotripsy（ESWL）were involved.SMP was performed using a F7 mini-nephroscope and a F10 nephrostomy sheath that possessed suction-evacuation function.Lithotripsy was performed using holmium：YAG laser or pneumatic lithotripsy.The stones in low pole,mid pole,pelvic-low pole,pelvicupper ureter were found in 27,3,5 and 3 cases,respectively.The mean stone size was（1.3±0.6）cm.Results All 38 patients were successfully punctured,35 of whom received single-channel lithotripsy,and3 required two nephrostomy tracts.The mean operation time was（37±12）min.One day after the operation,the stone clearance rate was 94.7%（36/38）.One case needed two sessions of SMP,and another one with residual stones located in lower calyx needed adjuvant treatment of ESWL.CT scan 4 weeks later showed all stones were completely removed.There was no pneumothorax,urinary extravasation,severe infection,bleeding or other complications.Conclusion SMP is technically feasible,safe and efficacious for the clinically significant residual fragments,especially as a salvaged treatment modality after the failure of ESWL or RIRS.

关 键 词：超微经皮肾镜取石术 临床有意义残石 输尿管软镜 体外冲击波碎石 

分 类 号：R692.4[医药卫生—泌尿科学]