经皮肾镜钬激光碎石治疗复杂性肾结石

目的探讨微创经皮肾镜钬激光碎石术（mPCNL）治疗复杂性肾结石的方法与效果。方法回顾性分析2005年9月～2008年2月我院mPCNL治疗83例复杂性肾结石患者的临床资料,术后随访并评价1个月结石清除率。结果83例患者手术均成功,无一例中转开放手术。一期单通道mPCNL手术43例,多通道mPCNL手术32例;二期mPCNL手术8例。平均手术时间142±28min,住院时间5.14±1.65d,术中出血量160±28ml,输血率20.48%（17/83）,无肾切除、肾功能受损、感染性休克等严重并发症,并发症发生率10.84%（9/83）;1个月结石清除率80.7%（67/83）。结论微创经皮肾镜钬激光碎石具有结石清除率高、创伤小、恢复快、并发症低等优点,是复杂性肾结石的首选治疗方法。

Treatment of complex renal calculi with minimally invasively pertutaneous nephrolithotomy combination with holmium laser

Objective To evaluate the feasibility and efficacy of minimally invasively pertutaneous nephrolithotomy combination with holmium laser(mPCNL)for the complex renal calculi.Methods Analysis of clinical data of 63 cases of complicated upper ureteral calculi treated by mPCNL was studied from September 2005 to February 2008.All cases were followed up for one month and the stone clearance rate was evaluated.Results No case was conversed to open surgery and all mPCNL operations were successful.43,32 cases were performed under single tract and multiple tracts mPCNL in a one-stage,respectively.8 cases were performed under mPCNL in two-stage.The average operation time,postoperative hospital stay,total operative blood loss and blood transfusion rate were(142±28)min,(5.14±1.65)days,(160±28)ml and 20.48%(17/83).The severe complications including nephrectomy,impaired renal function and septic shocks didn't happen.The complication rate was % and stone clearance rate at follow-up period of 1 month was 80.7%(67/83).Conclusion Minimally invasively pertutaneous nephrolithotomy combination with holmium laser has advantage of less invasive and complication,high stone clearance rate and earlier return to wok.It is safe and effective,which should be the first treatment for complicated ureteral calculi.