单通道经皮肾镜联合输尿管软镜治疗合并肾盏颈口狭窄的复杂肾结石疗效观察  

Efficacy of single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery in the treatment of complex renal stones with intrarenal strictures

作　　者：朱德胜[1] 张军平 徐旻[1] 吴海啸[1] 王斌 范文涛 黄汀 ZHU Desheng;ZHANG Junping;XU Min;WU Haixiao;WANG Bin;FAN Wentao;HUANG Ting(Department of Urology,Affiliated Jinhua Municipal Central Hospital,Zhejiang University School of Medicine,Jinhua 321000,China;不详)

机构地区：[1]金华市中心医院泌尿外科,321000 [2]东阳市红会医院泌尿外科

出　　处：《浙江医学》2024年第4期408-411,416,共5页Zhejiang Medical Journal

基　　金：金华市公益类项目(2019-4-119);金华市中心医院中青年科研启动基金(JY2020-2-11);浙江省医药卫生科技计划项目(2023KY1281)。

摘　　要：目的 探讨单通道经皮肾镜取石术(PCNL)联合输尿管软镜碎石术(RIRS)治疗合并肾盏颈口狭窄的复杂性肾结石的安全性及疗效。方法 回顾性分析2019年7月至2022年2月金华市中心医院收治的26例合并肾盏颈口狭窄的复杂性肾结石患者。所有患者均存在不同程度肾盏颈口狭窄伴肾盏积水,其中狭窄位于上盏21例,中盏3例,下盏2例;3例双侧肾结石,14例肾及输尿管多发结石,18例鹿角形结石。结石大小(40.6±13.5)mm,CT值(1 124.7±364.0)HU,结石负荷评分系统评分(8.7±0.8)分。所有患者均采用顺行PCNL联合RIRS。结果 26例患者均顺利完成手术并扩张狭窄通道留置双J管,平均手术时间(110.8±36.2)min。术中、术后均无严重出血和感染并发症。泌尿手术后并发症评分系统Ⅰ、Ⅱ级并发症发生率分别为7.7%(2例)、15.4%(4例),无Ⅲ级以上并发症。术后1个月复查腹部CT,一期结石取净率80.8%(21/26),二期结石取净率92.3%(24/26)。术后2~14 d拔除肾造瘘管,术后1~3个月拔除双J管。术后随访3~12个月,未见狭窄复发。结论 PCNL联合RIRS治疗合并肾盏颈口狭窄复杂性肾结石可有效扩张狭窄通道,结石取净率高且并发症少,是一种安全有效的治疗方案。Objective To explore the efficacy and safety of single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery in the treatment of complex renal stones with intrarenal strictures.Methods Clinical data of 26 patients with complex renal stones and intrarenal strictures admitted in Jinhua Municipal Central Hospital from July 2019 to February 2022 were retrospectively analyzed.All patients had varying degrees of intrarenal strictures with hydronephrosis,and the stones were located in the upper calyx in 21 cases,middle calyx in 3 cases,and lower calyx in 2 cases.3 cases had bilateral renal stones,14 cases had multiple stones in the kidney and ureter,and 18 cases had staghorn stones.The stone size was(40.6 ± 13.5) mm,CT attenuation value was(1 124.7 ± 364.0) HU,and the stone size,tract length,obstruction,number of involved calyces,and essence of stone density score was(8.7 ± 0.8).All cases underwent antegrade single-channel percutaneous nephroscopy plus retrograde ureteroscopy for stone fragmentation and removal.Results All 26 patients successfully completed the surgery,with the dilation of the narrowed passage and placement of the doble-J stent.The average operation time was(110.8 ± 36.2) min.No severe bleeding or infection occurred intraoperatively or postoperatively.The incidence rates of postoperative Clavien-Dindo grade Ⅰand Ⅱ complications were 7.7%(2 cases) and 15.4%(4 cases),respectively,while there were no complications of grade Ⅲ or higher.One month after operation,abdominal CT revealed a primary stone-free rate of 80.8%(21/26),and a secondary stone-free rate of 92.3%(24/26).The nephrostomy tube was removed 2-14 days postoperatively,and the double-J stent was removed 1-3 months postoperatively.During the 3-12 months of follow-up,no recurrence of obstruction was observed.Conclusion Single-channel percutaneous nephrolitholith combined with retrograde intrarenal surgery is effective and safe in treatment of complex renal stones with associated intrarenal strictures,which facili

关 键 词：输尿管软镜碎石术 经皮肾镜取石术 肾盏颈口狭窄 复杂性肾结石 治疗 

分 类 号：R699.2[医药卫生—泌尿科学]