大功率钬激光联合负压清石鞘在微通道经皮肾镜治疗上尿路结石中的应用  

Application value of high-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL for upper urinary tract calculi

作　　者：文焰林[1] 唐硕[1] 张宗平[1] 王安果[1] 伍季[1] 兰婷 杜跃林 WEN Yanlin;TANG Shuo;ZHANG Zongpin;WANG Anguo;WU Ji;LAN Ting;DU Yuelin(Department of Urology,Second Clinical Hospital of North Sichuan Medical College,Nanchong,Sichuan,637000,China;Operation room,Second Clinical Hospital of North Sichuan Medical College)

机构地区：[1]川北医学院第二临床学院南充市中心医院泌尿外科,四川南充637000 [2]川北医学院第二临床学院南充市中心医院手术室

出　　处：《临床泌尿外科杂志》2021年第4期273-275,280,共4页Journal of Clinical Urology

摘　　要：目的:探讨大功率钬激光联合负压清石鞘在微通道经皮肾镜取石术(mPCNL)治疗上尿路结石中的有效性和安全性。方法:应用大功率(60~80 W:1.5~2.0 J×40 Hz)钬激光联合负压清石鞘经F20经皮肾通道治疗肾结石及输尿管上段结石共311例,其中输尿管上段结石97例,肾盂结石23例,肾盂肾盏多发结石139例,鹿角形结石52例,其中独肾患者8例,术中采用钬激光碎石后利用负压清石鞘吸出结石,记录手术时间、结石清除率以及手术并发症,并与我院既往行的普通mPCNL336例患者的相关资料进行比较。结果:311例患者术中发现脓肾患者2例,予以肾造瘘后二期手术治疗,所有患者术中、术后均未出现脓毒症,1例患者术后发生急性肾损伤及术后延迟性出血予以介入止血并输血治疗,2例患者发生气胸,1例予以胸腔闭式引流,1例予以保守治疗,平均手术时间为(76.67±50.22)min,结石清除率为88.1%,既往mPCNL的平均手术时间为(119.00±26.06)min,结石清除率为61.01%,两组患者的手术时间和结石清石率对比有显著性差异。结论:应用大功率钬激光联合负压清石鞘在mPCNL治疗上尿路结石可以明显缩短手术时间、提高结石清除率,值得临床应用及推广。Objective:To investigate the efficacy and safety of high-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL for upper urinary tract calculi.Methods:Three hundred and eleven cases of renal calculi and upper ureteral calculi were treated by high-power(60-80 W:1.5-2.0 J×40 Hz)holmium laser combined with negative pressure lithotripsy through F20 mPNL,including 97 cases of upper ureteral calculi,23 cases of renal pelvis calculi and 139 cases of multiple calculi of renal pelvis and calices.There were 52 cases of staghorn calculi,and 8 of which were single kidney patients.The operation time,stone clearance rate and complications were recorded.Results:Two patients with pyonephrosis were found in the high-power holmium laser combined with negative pressure lithotripsy sheath group,then they underwent two-stage operation after nephrostomy.All patients did not have sepsis during and after operation.One patient suffered from acute renal injury and delayed bleeding after operation and received interventional hemostasis and blood transfusion.Two patients developed pneumothorax.One patient received closed drainage of chest,and the other received conservative treatment.The average operation time was(76.67±50.22)min,and the stone clearance rate was 88.10%.The average operation time of the conventional mini-PCNL was(119.00±26.06)min,and the stone clearance rate was 61.01%.There was significant difference in the operation time and stone clearance rate between the two groups.Conclusion:High-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL in the treatment of upper urinary tract calculi can significantly shorten the operation time and improve the stone clearance rate,so it’s worthy of clinical application and promotion.

关 键 词：大功率钬激光 清石鞘 微通道经皮肾镜碎石术 上尿路结石 

分 类 号：R691.4[医药卫生—泌尿科学]