微造瘘经皮肾钬激光碎石取石术治疗复杂性肾结石

目的:探讨微造瘘经皮肾钬激光碎石取石术(MPCNL)治疗复杂性肾结石的疗效.方法:对38例接受MPCNL治疗的复杂性肾结石患者的临床资料进行回顾性分析.结果:本组38例均成功进行了经皮微穿刺肾造瘘,在输尿管镜下完成了钬激光碎石术,无中转行开放手术.行I期取石37例,一次取尽结石34例,3例术后残余结石配合体外冲击波碎石(ESWL)治愈; 1例于术后1周经原造瘘通道行II期经皮肾钬激光碎石取石术治愈.平均手术时间140 min,出血50～100 ml;术后肾造瘘管留置时间5～7 d,住院天数平均9 d.无大出血、尿瘘、动静脉瘘、腹腔脏器损伤等严重的并发症.肾结石总取净率92.1%(35/38).结论:MPCNL联合钬激光碎石取石术具有创伤小、恢复快、出血少、住院时间短、结石清除率高、并发症少等优点,是治疗复杂性肾结石的较好的微创方法.

Minimally Invasive Percutaneous Nephrolithotomy with Holmium Laser for the Treatment of Complicated Renal Stones

Objective：To explore the efficacy of the minimally invasive percutaneous nephrolithotomy （MPCNL） with holmium laser for the treatment of complicated renal stones. Methods：Data of 38 patients underwent MPCNL for complicated renal stones from July 2009 to July 2011 were reviewed and evaluated. Resuits：Minimally invasive pereutaneous nephrolithotomy procedures were performed on 38 cases in this group. No case required conversion to open surgery. The renal stones were evacuated in 37 cases by one - stage procedure ,34 cases were stone free after one- stage MPCNL, 3 cases of postoperative residual stones with extracorporeal shock wave lithotripsy （ ESWL ） therapy to cure ; 1 case was given two - stage MPCNL by quondam orificium fistulae at 1 week after one - stage procedure . The average operation time was 140 minutes, Blood loss was 50 - 100ml ; average nephrostomy tube indwelling time was 5 - 7 days, the average hospitalization stay was 9 days. No severe introoperative complications occurred. The total stone free rate was 92.1%. Conclusions： MPCNL with Holmium laser offer advantages with respect to less invasion, easy recovery, less blood loss, short hospitalization stay, high stone free rate and less complications. It＇ s a better minimally invasive way for complicated renal stones than others.