Holmium: YAG laser lithotripsy for gallstones. A preliminary report

BACKGROUND: Most retained gallstones can be extracted at the time of operative exploration or endoscopic retrograde cholangiopancreatography (ERCP). Infrequently, impaction or associated anatomic abnormalities may prevent their clearance. We assessed the efficacy of the holmium:YAG laser in managing retained biliary calculi that had proven refractory to the usual methods of extraction. METHODS: Two patients with calculi impacted in the intrapancreatic common bile duct and one patient with residual stones in a nonfunctional gallbladder were treated with holmium:YAG laser lithotripsy. Two of these patients were treated under conscious sedation, and one received a general endotracheal anesthetic. Laser energy was delivered by a 272-mm optical fiber inserted through a 7-Fr fiberoptic endoscope. The ablative effects were monitored continuously via videoscopic. RESULTS: All of the stones were cleared successfully in a single therapeutic setting. In one patient, fragments of the impacted intraductal stone were extracted with an endoscopic wire basket. In the other two patients, stone debris was completely cleared with saline irrigation. No complications developed, and all patients remained free of recurrence during a 6-month follow-up period. CONCLUSIONS: The holmium:YAG laser is a multidisciplinary instrument that is safe and effective in the fragmentation of both urinary and biliary calculi. Because it can be delivered through a small-caliber fiberoptic endoscope, it should be particularly useful to laparoscopic surgeons who manage complicated biliary tract disease.     

输尿管镜碎石取石术治疗23例经皮肾术后肾中上盏残余结石

目的 探讨输尿管镜钬激光联合气压弹道碎石取石术治疗经皮肾术后肾中上盏残余结石的疗效.方法 用钬激光治疗仪结合Fr8.0/9.8输尿管硬镜下联合气压弹道碎石取石术治疗经皮肾术后肾中上盏残余结石23例,观察其疗效.结果 23例患者共有结石103枚,结石大小8 ～ 36mm,结石寻及率100.0％,一次结石粉碎成功率98.1％,无严重并发症发生.结论 输尿管镜碎石取石术治疗经皮肾术后肾中上盏残余结石是一种可行的疗效优良、安全、经济的微创方法.     

Ureteroscopic management of recurrent renal cystine calculi

BACKGROUND AND PURPOSE: Patients with recurrent cystine nephrolithiasis oftentimes require multiple procedures for stone removal. As the majority of cystine stones are resistant to the effects of shockwave lithotripsy, repeat percutaneous surgery is often required and may cause renal damage. Moreover, repeat percutaneous access may become more difficult as perinephric fibrosis develops. Small-caliber ureteroscopes along with the holmium laser now enable routine intrarenal ureteroscopic access to symptomatic renal stones. Herein, we present our experience in managing recurrent renal cystine calculi using flexible ureterorenoscopy and assess whether such an approach may be used as an alternative to percutaneous surgery in selected patients. PATIENTS AND METHODS: Three patients with large-volume (mean diameter 22 mm) renal cystine stones were managed with a 7.5F flexible ureterorenoscope combined with holmium laser lithotripsy to fragment the stones completely. RESULTS: The mean treatment time was 97 minutes, with successful fragmentation in all cases. Two of the three patients were completely stone free on follow-up intravenous urography, with the third patient having only small-volume residual fragments in a lower pole calix. All patients are currently asymptomatic and are being maintained on high oral fluid intake, urinary alkalization with potassium citrate, and alpha-mercaptopropionylglycine to reduce urinary cystine excretion. CONCLUSION: Flexible ureterorenoscopy with holmium laser lithotripsy provides a reasonable alternative for the management for recurrent cystine calculi in patients who are not candidates for repeat percutaneous procedures. Although it is time consuming, complete stone fragmentation, along with clearance of fragments, can be achieved in the majority of patients.     

经输尿管镜钬激光治疗输尿管结石的临床分析(附350例报告)

目的 探讨经输尿管镜钬激光治疗输尿管结石的临床效果. 方法 选取2009年5月～ 2011年6月收治的350例输尿管结石患者,均行经输尿管镜钬激光碎石术. 结果 350例输尿管结石患者中321例一次碎石成功,治疗成功率为91.7％(321/350).手术时间平均48.6(20 ～ 115 )min;术后住院时间平均5.2(4 ～7)d.术中结石移位18例,其中16例留置双J管后1～4周内再行补救性体外冲击波碎石术,另2例换经输尿管软镜钬激光肾内碎石.D-J管常规留置时间为3～4周.因输尿管迂曲、狭窄不能进镜达结石部位11例,均中转开放手术取石.术中发生输尿管粘膜下损伤6例,输尿管穿孔4例.术后当天出现畏寒、发热,体温＞38.5C者19例,给予静脉抗感染和对症治疗后均恢复正常.术后结石残留造成再次输尿管梗阻6例,经再次输尿管镜碎石术后好转.术后3个月339例获随诊,结石均获清除,结石清除率达96.9％(339/350). 结论 经输尿管镜钬激光治疗输尿管结石具有安全、高效、创伤小、并发症少、成功率高、住院时间短等优点,是目前输尿管结石的最理想治疗方法.     

Percutaneous Endoscopic Holmium Laser Lithotripsy for Management of Complicated Biliary Calculi

Background and Objectives:

Advances in endoscopic techniques have transformed the management of urolithiasis. We sought to evaluate the role of such urological interventions for the treatment of complex biliary calculi.

Methods:

We conducted a retrospective review of all patients (n=9) undergoing percutaneous holmium laser lithotripsy for complicated biliary calculi over a 4-year period (12/2003 to 12/2007). All previously failed standard techniques include ERCP with sphincterotomy (n=6), PTHC (n=7), or both of these. Access to the biliary system was obtained via an existing percutaneous transhepatic catheter or T-tube tracts. Endoscopic holmium laser lithotripsy was performed via a flexible cystoscope or ureteroscope. Stone clearance was confirmed intra- and postoperatively. A percutaneous transhepatic drain was left indwelling for follow-up imaging.

Results:

Mean patient age was 65.6 years (range, 38 to 92). Total stone burden ranged from 1.7 cm to 5 cm. All 9 patients had stones located in the CBD, with 2 patients also having additional stones within the hepatic ducts. All 9 patients (100%) were visually stone-free after one endoscopic procedure. No major perioperative complications occurred. Mean length of stay was 2.4 days. At a mean radiological follow-up of 5.4 months (range, 0.5 to 21), no stone recurrence was noted.

Conclusions:

Percutaneous endoscopic holmium laser lithotripsy is a minimally invasive alternative to open salvage surgery for complex biliary calculi refractory to standard approaches. This treatment is both safe and efficacious. Success depends on a multidisciplinary approach.     

Management of complex biliary tract calculi with a holmium laser

The difficulty in managing complex biliary tract calculi is exemplified in patients with primary intrahepatic calculi. Standard surgical and endoscopic approaches often fail to clear calculi in these patients who have recurrent episodes of cholangitis. The success of the holmium laser for urologic calculi led us to adapt treatment strategies for primary and secondary biliary tract calculi where standard treatments had been unsuccessful. Our goals were to remove all calculi, prevent recurrent sepsis, and preserve hepatic parenchyma. Thirty-six patients with complex biliary calculi were treated. After sepsis was controlled and the extent of calculi was evaluated, appropriate access to and drainage of the biliary tract was achieved. Holmium laser lithotripsy was performed under video guidance using flexible choledochoscopes and a 200 μ laser fiber generating 0.6 to 1.0 joules at frequencies of 6 to 10 Hz. Lithotripsy procedures were repeated until cholangiography and cholangioscopy confirmed the clearance of calculi. Twenty-two patients of Asian descent with primary intrahepatic calculi and 14 patients with secondary intrahepatic calculi were treated. Access to the biliary tract could be accomplished through percutaneous catheter tracts, T-tube tracts, or the cystic duct during laparoscopic cholecystectomy. Biliary drainage was by biliary enteric anastomosis or endoscopic sphincterotomy. Complete stone clearance required an average of 3.9 procedures (range 1 to 15) for patients with primary intrahepatic calculi and 2.6 procedures (range 1 to 10) for patients with secondary intrahepatic calculi regardless of stone composition. No patient required hepatic resection and no complications or deaths were attributed to the holmium laser. Clearance of calculi can reliably and safely be achieved with a holmium laser regardless of stone composition or location while preserving hepatic parenchyma and preventing recurrent sepsis. Presented at the Fourth Americas Hepato-Pancreato-Biliary Association Congress, Miami Beach, Florida, February 27-March 2, 2003.     

A comparison of holmium:YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation

PURPOSE: Among various intracorporeal lithotriptors, Lithoclast (EMS, Switzerland) has become the widely used tool for the treatment of urinary stones. Recently, the holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. The purpose of the present study is to compare Lithoclast with holmium:YAG laser lithotripsy in ureteral calculi fragmentation. METHODS: Out of 51 patients with ureteral calculi, 26 underwent Lithoclast lithotripsy and 25 holmium:YAG lithotripsy using a 8/9.8F rigid ureteroscope. There were no changes to the ureteroscopes, video monitors, baskets or irrigation devices during the study period. RESULTS: There were no differences in patient age, sex, stone size and location of stones between these groups. The immediate stone-free rates were 96.0% in the holmium:YAG group and 73.1% in the Lithoclast group (P < 0.05). The 3-month stone-free rates were 96.0% and 84.6%, respectively (P = 0.350). The mean operation time and mean period of postoperative hospitalization in the holmium:YAG group (49.8 min and 1.0 days, respectively) were shorter than those of the Lithoclast counterpart (76.9 min and 2.5 days, respectively). Post-treatment complications, such as ureteral perforation, were encountered in only two patients who underwent Lithoclast. CONCLUSIONS: Holmium:YAG lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data also suggest that holmium:YAG lithotripsy was safe and more effective than Lithoclast lithotripsy in the aspect of immediate stone free rate. We believe that holmium:YAG laser is an excellent treatment modality for managing ureteral calculi.     

分期微通道经皮肾治疗合并尿脓毒症输尿管上段结石的临床分析

目的探讨采用分期微通道经皮肾手术治疗合并尿脓毒症输尿管上段结石的疗效。方法自2011年8月至2016年1月收治的24例合并尿脓毒症输尿管上段结石患者采用分期手术治疗,对其术后出现感染性休克,出血,结石残留等并发症进行分析。结果本组24例均完成Ⅰ期肾造瘘、Ⅱ期钬激光碎石。Ⅰ期肾造瘘术后15例不同程度发热,其中2例出现感染性休克,治疗后病情转平稳;Ⅱ期钬激光碎石一次碎石及清石,结石清除率为100%。术中无较严重出血,术后有2例出现发热,无感染性休克、输尿管撕脱、穿孔等并发症。结论采用分期微通道经皮肾手术治疗合并尿脓毒症输尿管上段结石,能有效解除梗阻,控制感染,且创伤小、安全可靠,可减少并发症的发生,具有较高临床价值。     

超声定位微创经皮肾穿刺造瘘钬激光治疗复杂肾结石

目的:探讨提高治疗复杂肾结石疗效的新方法。方法:采用超声定位微创经皮肾穿刺造瘘钬激光治疗复杂肾结石58例。结果:平均治疗时间1.5 h,结石清除率84.4%,5例术后因肾盏结石残留再行ESWL治疗。随访全部病例,时间5~12个月,49例未见结石复发;9例有肾盏小结石残留。结论:超声定位微创经皮肾穿刺造瘘钬激光治疗复杂性肾结石,具有目标准确、肾组织损坏小、术中安全、结石清除率高等优点,值得推广应用。     

Single upper-pole percutaneous access for treatment of > or = 5-cm complex branched staghorn calculi: is shockwave lithotripsy necessary?

BACKGROUND AND PURPOSE: Percutaneous nephrolithotomy for staghorn calculi is reported to have a residual stone rate of 28%, while shockwave lithotripsy alone results in residual stones in approximately 50% of cases. Combination therapy, sandwich therapy, and multiple percutaneous accesses have also been advocated for staghorn stones. We believe these stones can often be removed with a staged procedure via a single upper-pole percutaneous access using flexible nephroscopy and the holmium:YAG laser. Our experience is reviewed. PATIENTS AND METHODS: The hospital records of patients having a cumulative stone burden > or =5 cm who underwent percutaneous nephrolithotripsy (PCNL) for a single complex staghorn calculus were reviewed. There were 15 male and 34 female patients having 45 complete and 7 partial staghorn calculi constituting a mean stone burden of 6.7 cm (range 5.0-10.0 cm). A calix was punctured that would provide access to the majority of the involved calices. Thirty-five renal units were approached through a single upper-pole percutaneous access, and four and six renal units were accessed through single middle or lower-pole calices, respectively. The remaining seven renal units were treated with multiple percutaneous accesses. RESULTS: In the renal units having only a single access, a mean of 1.6 (range 1-3) procedures were required to achieve stone-free status. The mean operating room time was 2.9 hours (range 2.0-3.5 hours). For the second PCNL, the mean operating room time was 63 minutes (range 30-90 minutes). Two patients (two renal units) had residual stones <1 cm in diameter. One refused additional surgery, and the other is awaiting further treatment. The mean estimated blood loss was 238 mL (range 50-800 mL), with only one procedure (2.2%) necessitating a blood transfusion. One (2.8%) hydrothorax developed among the 35 upper-pole puncture cases. Six patients had transient oral temperature readings >101 degrees F with negative blood cultures. Other early complications included single cases of leg cellulitis, atrial fibrillation, and noncardiac chest pain. There were no delayed surgical complications. Patients were discharged from the hospital a mean 2 days (range 1-10 days) after the first PCNL. CONCLUSION: Use of flexible nephroscopy with holmium:YAG laser lithotripsy and Nitinol basket stone extraction has allowed us to render staghorn-containing renal units stone free in a mean of 1.6 procedures. Of the 45 renal units treated through a single percutaneous access, 43 (95%) were rendered stone free. The holmium:YAG laser appears to be a safe lithotrite for the kidney, as no complications occurred from its use.     

经皮肾镜取石术在复发性肾结石二次手术中的治疗效果

目的：评价经皮肾镜取石术在复发性肾结石二次手术中的临床效果及安全性。方法：回顾分析我院2010年6月至2013年7月间经皮肾镜取石术治疗24例复发性肾结石二次手术病例的临床资料。 结果：24例患者均行一期PCNL手术,术后腹部平片显示,21例结石清除干净,净石率为87.5%;3例术后有残石者,1例患者系术中取石失败,术后行体外冲击被碎石术,1例行经输尿管镜碎石取石术,1例行第二次经皮肾镜取石术并术后辅以体外冲击被碎石术。手术时间40～110min,平均80min。术后无严重并发症发生。结论：经皮肾镜取石术是复发性肾结石二次手术治疗安全、有效的方法。     

标准通道经皮肾镜气压弹道碎石与联合钬激光碎石术治疗复杂性肾结石的疗效比较

目的:比较标准通道经皮肾镜气压弹道碎石及气压弹道联合钬激光碎石术治疗复杂性肾结石的疗效。方法:回顾性分析本院2019年3月至2020年3月采用标准通道经皮肾镜气压弹道碎石与标准通道下经皮肾镜气压弹道联合钬激光碎石术治疗的170例复杂性肾结石患者的临床资料,按照手术碎石方式不同,随机分为对照组(78例)、观察组(92例)...     

Intracorporeal Lithotripsy With the Holmium:YAG Laser

Purpose

Preliminary evaluations of the holmium:YAG laser have demonstrated a variety of potential urological applications, including ablation of soft tissue lesions as well as stone fragmentation. We present our experience with the holmium:YAG laser for intracorporeal lithotripsy of urinary calculi.

Materials and Methods

During a 24-month period 75 patients underwent 79 laser procedures, including retrograde ureteroscopy for ureteral calculi (71) and fragmentation of caliceal stones remote from the nephrostomy tract during percutaneous nephrolithotripsy (8).

Results

Complete stone fragmentation without need for additional procedures or lithotripsy was achieved in 85 percent of the cases. Treatment failures included 1 case of stone migration, 7 incomplete fragmentation requiring other lithotripsy devices and 3 laser malfunction. One ureteral perforation occurred when the laser was activated without direct visual guidance.

Conclusions

The holmium: YAG laser has demonstrated its efficacy as a method of intracorporeal lithotripsy. Advantages include ability to fragment stones of all composition, and the multipurpose, multispecialty applications of the holmium wavelength. This laser has potential soft tissue effects, and careful attention to technique during lithotripsy is required to avoid ureteral wall injury.     

输尿管镜联合钬激光治疗输尿管上段结石:附205例报告

目的 探讨输尿管镜联合钬激光治疗输尿管上段结石的效果和安全性.方法 回顾性分析205例输尿管上段结石患者行输尿管硬镜钬激光碎石治疗的临床资料,其中男91例,女114例,结石位于单侧188例,双侧17例,炎性息肉引起输尿管腔明显狭窄者12例.结石长径0.8～1.4 cm.结果 192例一次性碎石成功,单次碎石成功率为93.7%(192/205).9例有较大结石碎片(4～6 mm)残留于肾或输尿管内,4例在碎石过程中结石冲入肾内,其中1例较大结石(1.4 cm)移位至肾盂后改行PCNL,其余3例留置双J管改行ESWL,均治愈.19例合并炎性息肉同期行激光烧灼.手术时间15~90min,平均30 min.住院时间2~9 d,平均3.5 d.198例患者在门诊获得随访,随访时间3～24个月,平均6个月,结石均排尽.结论 输尿管镜联合钬激光治疗输尿管上段结石的一种比较理想的腔内碎石技术,其碎石成功率高,并发症发生率低,创伤小,患者术后恢复快,而且可同期处理结石合并炎性息肉和狭窄.     

Percutaneous nephroscopic with holmium laser and ultrasound lithotripsy for complicated renal calculi

The aim of this work is to validate the clinical efficacy of the high-power holmium:YAG laser with percutaneous nephrolithotripsy (PCNL) in combination with ultrasound lithotripsy for complicated renal calculi. From November 2006 to December 2007, 60 patients with complicated renal calculi were treated with PCNL, where an F24 standard renal access tract was established by percutaneous renal puncture under the guidance of B-mode ultrasound, and stones were fragmented and cleared by high-power holmium laser in combination with ultrasound under an F20.8 nephroscope. Of the 60 patients with complicated renal calculi, 20 were complete staghorn calculi and 30 were partial staghorn calculi, of which six patients were accompanied with renal insufficiency; two were solitary calculi, and eight were caliceal diverticular calculi. Calculi were removed by one attempt in 49 patients and by two attempts in 11 patients; through one tract in 50 patients and through two and three tracts in ten patients. The stone-free rate was 81.7%. No injury to the pleura and abdominal organs occurred during the intraoperative puncture. No postoperative blood transfusion was needed in any patient, nor did fever and secondary hemorrhage occur. The mean operation duration was 98 min (range, 60–150 min), and the mean lithotripsy time was 45 min (range, 30–85 min). Additional postoperative extracorporeal shock wave lithotripsy (ESWL) was performed on six patients. High-power holmium laser PCNL in combination with ultrasound lithotripsy is safe, effective, and minimally invasive, with a high stone-free rate, especially for complicated renal calculi.     

胆道镜联合钬激光碎石治疗肝内胆管结石的临床体会

目的:探讨腹腔镜下胆道镜联合钬激光治疗肝内胆管结石的效果及临床价值。方法:回顾分析2008年6月至2012年6月124例胆道结石患者的临床资料,其中60例行腹腔镜下胆道镜联合钬激光碎石术(观察组),64例行传统开腹手术,术中配合胆道镜取石,未使用钬激光(对照组)。结果:观察组中58例(96.7%)结石完全取净,手术时间平均(98.93±10.66)min,平均住院(8.3±1.7)d,术后残余结石2例,经T管窦道胆道镜再次取石成功。对照组中38例(59.4%)取净结石,手术时间平均(122.8±13.43)min,平均住院(13.98±1.49)d;残余结石26例,术后经T管窦道胆道镜再次取石,其中6例经2次取石,3次、4次取石及再次开腹手术各2例。两组患者手术时间及住院时间差异有统计学意义(P<0.01),术后胆道出血、肝功能异常、腹水等并发症发生率差异无统计学意义(P>0.05)。结论:腹腔镜下胆道镜联合钬激光治疗肝内胆管结石具有患者创伤小、康复快、碎石确切、安全有效等优点,为治疗肝内胆管结石开辟了新的治疗途径。     

B超引导微通道经皮肾镜钬激光治疗上尿路结石105例

目的探讨B超引导下微通道经皮肾镜钬激光碎石术治疗上尿路结石的疗效。方法2008年9月～2011年12月105例上尿路结石在B超引导下18G肾穿刺针穿刺,建立F14～F16皮肾微通道,置入Wolf8.0/9.8输尿管镜,65W钬激光将结石粉碎,放置F5双J管作内引流,F14硅胶肾造瘘管外引流。结果91例（86．6％）单通道一期碎石成功;9例单通道二期碎石成功（8．5％）,其中2例二期术后仍小结石残留行体外震波碎石后结石排净;5例穿刺失败：2例1～3次ESWL辅以中药排石治疗后结石排净,3例中转开放切开取石手术,穿刺失败率4．7％（5／105）。手术时间70—150min,（80．5±10．2）min;术中出血量20～100ml,平均50ml,无大出血。105例随访10～32个月,（10．6±3．5）月,4例结石复发,因结石偏小行中医排石汤排石后治愈。结论B超引导下微通道经皮肾镜下钬激光碎石治疗上尿路结石安全、有效。     

标准通道经皮肾镜取石术联合输尿管软镜钬激光碎石术对上尿路结石患者的结石清除率、肾功能指标及血流动力学的影响

目的 研究标准通道经皮肾镜取石术(SPCNL)联合输尿管软镜钬激光碎石术(FURS)对上尿路结石患者结石清除率、肾功能指标及血流动力学的影响。方法 选取2017年3月至2019年6月入院的84例上尿路结石患者，参考随机数字表法分为两组，各42例，对照组SPCNL治疗，研究组联用SPCNL与FURS治疗。比较两组手术前后肾功能指标[β2 微球蛋白、血肌酐、血尿素氮（BUN）]、血流动力学指标（中心静脉压、平均动脉压及心率）水平与术后结石清除率、手术时间、肾造瘘管留置时间、住院时间及并发症发生率。结果 两组术前肾功能指标、血流动力学指标水平比较，差异无统计学意义（P＞0.05）；对比术前，两组术后肾功能指标水平更高（P＜0.05），而两组术后血流动力学指标比较，差异无统计学意义（P＞0.05）；两组术后肾功能指标、血流动力学指标水平与并发症发生率比较，差异无统计学意义（P＞0.05）；对比对照组，研究组术后结石清除率更高，手术时间更长，肾造瘘管留置时间、住院时间更短（P＜0.05）。结论 SPCNL联合FURS治疗上尿路结石的效果显著，虽然手术时间长于单用SPCNL，但术后结石清除率更高，且对患者血流动力学指标的影响较小，可有效改善肾功能。 〖HT5”H〗〓〓【关键词】〓〖HT5”SS〗尿路结石；肾造口术, 经皮；输尿管镜检查；碎石术, 激光 〖HT5”H〗〓〓DOI：〖HT5”SS〗10.3760/cma.j.cn431460 20190203 00001     

微创经皮肾镜钬激光碎石术治疗肾脏结石96例分析

目的 探讨微创经皮肾镜取石术（minimally invasive percutaneous nephrolithotomy,MPCNL）治疗肾脏结石的疗效和安全性.方法 2008年1月～ 2013年1月96例肾脏结石在B超引导下定位穿刺,建立F18经皮肾工作通道,通过F8.0/98输尿管硬镜找到结石,采用60 W钬激光将其击碎、取出,留置F16肾造瘘管.结果 术中因经皮肾穿刺术失败改开放手术2例（2.1％）.94例顺利完成手术,其中单通道取石85例,双通道9例;一期取石81例,二期取石13例;手术时间80 ～160 min,平均100 min;76例取净结石,结石清除率80.8％（76/94）.术中输血11例,术后输血7例,术后迟发性大出血2例,行超选择性肾动脉栓塞后治愈.18例术后结石残留,体外冲击波碎石联合药物排石治愈.平均住院11 d（9～25 d）.94例随访6～ 12个月,平均8个月,5例结石复发;术前合并肾积水65例,术后33例肾积水消失,25例肾积水较术前减轻,7例肾积水较术前无明显变化.结论 MPCNL治疗肾脏结石并发症少,手术安全性及结石清除率高,疗效满意.     

肾镜联合输尿管软镜通过经皮肾单通道取石治疗肾鹿角形结石

目的探讨肾镜联合输尿管软镜通过20 F经皮肾单通道碎石取石一期治疗肾鹿角形结石的效果。 方法回顾性分析2014年1月至2016年8月我院37例采用肾镜联合输尿管软镜通过经皮肾单通道治疗的鹿角形肾结石患者的临床资料,男14例,女23例。年龄34～62岁,平均（46±13）岁,其中左侧25例、右侧12例。结石直径3.3 cm～6.0 cm,平均（4.9±0.1）cm。采用超声引导穿刺下经皮肾穿刺单通道取石,扩张通道至20 F,应用超声或钬激光碎石。 结果37例患者均一期建立20 F皮肾单通道,36例一期行肾镜联合输尿管软镜通过经皮肾单通道碎石取石,经下盏建立皮肾通道34例（91.9%）,一期结石清除率86.5%（32/37）,一期手术时间58～125 min,平均（92±23）min。术后当日测血红蛋白下降3.2～9.5 g/L,平均（5.7±1.8）g/L。术后住院时间5～9 d,平均（7±1）d。3例患者术后体温≥38.5℃。37例患者均无大出血及输血,无尿脓毒症,无肾脏穿孔及胸腹腔积液等并发症。 结论肾镜联合输尿管软镜通过20 F经皮肾单通道碎石取石一期治疗肾鹿角形结石,结石清除率高、创伤小、并发症少。