微创经皮肾镜取石术联合Ⅱ期逆行输尿管软镜治疗复杂性肾结石的疗效观察

目的探讨微创经皮肾镜取石术联合Ⅱ期输尿管软镜治疗复杂性肾结石的安全性及可行性。方法收集2010年1月至2014年12月收治的122例复杂性肾结石患者的资料,其中78例多发性肾结石,44例肾铸型结石,结石直径范围为1.5~5.0cm,其中74例患者出现不同程度的尿素氮及肌酐水平升高;所有患者均行Ⅰ期微创经皮肾镜碎石术,术后3~5d再行Ⅱ期逆行输尿管软镜取石术,收集所有患者术前、术后各项生化指标并获取随访资料。结果患者Ⅰ期微创经皮肾镜手术时间为30~180min,术后均有结石残留;Ⅱ期输尿管软镜手术时间20~100min,Ⅱ期结石总清除率为93.44%(114/122),余8例患者术后行体外冲击波碎石治疗后结石均排出;随访1~18个月后,所有患者均未见残余结石梗阻、石街及移位等。结论微创经皮肾镜取石术联合Ⅱ期逆行输尿管软镜可以应用于复杂性肾结石的临床治疗。     

单通道经皮肾镜取石术联合逆行输尿管软镜治疗复杂性肾结石疗效观察(附79例报告)

目的:探讨单通道微创经皮肾镜取石术联合逆行输尿管软镜治疗复杂性肾结石的有效性及安全性。方法:回顾分析2011年1月～2012年2月收治79例复杂性肾结石患者的临床资料:铸型肾结石25例,肾多发结石54例,结石直径1.2～4.8cm,其中功能性孤立肾24例,血肌酐及尿素氮有不同程度升高31例。采用一期单通道微创经皮肾镜取石术、二期截石斜仰卧位下联合逆行输尿管软镜碎石取石术进行治疗。结果:所有手术均获得成功,建立F20工作通道并一期碎石取石,一期手术时间32～176min,平均(85±16)min。二期手术时间18～134min,平均(46±21)min,二期术后结石总清除率为92.4%(73/79)。6例结石残留患者术后1个月行ESWL治疗,4例结石完全排出,2例残留结石直径均小于1.0cm。未出现气胸、肠道损伤及大出血等严重并发症。结论:单通道经皮肾镜取石术联合逆行输尿管软镜治疗复杂性肾结石有利于减少手术并发症并提高结石清除率,方法安全、有效,值得临床推广。     

单通道经皮肾镜取石术结合输尿管软镜治疗鹿角状肾结石

目的:探讨单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石的手术效果.方法:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石96例.结石大小2.9cm×3.4 cm～3.8 cm×5.5 cm,平均3.5 cm×4.2 cm.结果:96例均采用单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石,一期手术平均手术时间为118 min;结石清除率为82.3%(79/96),二期手术平均手术时间为55 min,结石总清除率92.7%(89/96).7例患者残留结石,大小0.3～1.0 cm,其中5例术后1个月接受ES-WL治疗.术后随访7例残留结石患者2～6个月,结石清除5例.结论:单通道经皮肾镜气压弹道碎石结合输尿管软镜钬激光碎石治疗鹿角状肾结石具有手术时间短、结石清除率高、创伤小、并发症少、周围脏器损伤风险小等优点,可作为鹿角状肾结石的治疗方法.     

单通道微创经皮肾镜联合输尿管软镜治疗复杂性肾结石疗效观察

目的探讨单通道微创经皮肾镜钬激光碎石术联合输尿管软镜钬激光碎石术治疗复杂性肾结石的手术效果。方法回顾性分析我科使用单通道微创经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石78例。其中铸型结石或大结石(2.5cm)35例,肾盂肾盏多发性结石43例。手术采用B超引导下单通道微创经皮肾镜(F16/F18)及输尿管软镜配合钬激光方式进行。术后复查尿路平片或双肾CT评估手术效果,残留结石≥4mm为临床有意义的结石残留。结果观察组所有手术均成功建立经皮肾工作通道碎石取石,其中76例一期联合输尿管软镜处理残留结石,2例行二期手术。一期手术平均时间为(92±18)min,结石清除率为85.9%(67/78);二期手术平均时间为(46±11)min,结石总清除率94.9%(74/78)。4例患者残留结石,大小约0.4~0.9cm,给于体外碎石治疗,术后随访3~6个月,结石清除3例。78例患者均未出现气胸、肠道损伤、输尿管黏膜撕脱、输尿管断裂、大出血或脓毒血症等严重并发症。与对照组相比差异有统计学意义(χ2=4.047,P0.05)。结论单通道微创经皮肾镜联合输尿管软镜治疗复杂性肾结石具有手术时间短、创伤小、并发症少、结石清除率高等优点,具有良好的有效性和安全性,值得临床广泛推广。     

多通道微创经皮肾镜取石术治疗复杂性肾结石的效果观察

目的探讨多通道微创经皮肾镜取石术治疗复杂性肾结石的效果。方法将2014-01—2015-12间治疗的198例复杂性肾结石患者根据治疗方式不同分为2组。单通道组(96例)行单通道微创经皮肾镜取石术,多通道组(102例)行多通道微创经皮肾镜取石术。比较2组患者手术情况、Ⅰ期和Ⅱ期结石清除率及术后并发症发生率。结果 2组患者手术时间、术中出血量及住院时间比较差异无统计学意义(P0.05)。多通道组患者Ⅰ期和Ⅱ期结石清除率明显高于单通道组,术后并发症发生率低于单通道组,差异均有统计学意义(P0.05)。结论多通道微创经皮肾镜取石术治疗复杂性肾结石,能提高结石清除率及降低术后并发症发生率。     

二期逆行输尿管软镜联合经皮肾镜治疗鹿角形肾结石

目的探讨二期逆行输尿管软镜联合经皮肾镜处理鹿角形肾结石的效果。方法 2012年1月~2014年12月对23例鹿角形结石行经皮肾镜碎石取石术,采用F16~F24通道,使用钬激光或EMS碎石清石系统碎石,将可及肾盂、肾盏内结石清除,顺行置入双J管并留置肾造瘘管,术后复查均有结石残留,术后7~15 d先逆行输尿管软镜碎石,再通过一期经皮肾通道将碎石冲出或采用EMS清石系统将结石吸出。结果 23例一期采用单通道经皮肾镜碎石取石术,均无胸膜、肠道损伤及大出血、感染性休克等并发症,术后复查CT平扫或CTU均有结石残留,测量残留结石直径0.7~2.8 cm,平均1.6 cm。术后7~15 d行二期输尿管软镜联合经皮肾镜碎石取石术,结石清除率82.6%(19/23),手术过程均顺利,无严重感染、出血及输尿穿孔等并发症。3例术后行ESWL后结石减少;1例拒绝进一步治疗,随访观察。结论二期输尿管软镜联合经皮肾镜治疗鹿角形肾结石安全、有效。     

微创经皮肾镜联合顺行组合式输尿管软镜治疗鹿角形肾结石16例报告

目的:探讨微创经皮肾镜联合顺行组合式输尿管软镜处理鹿角形肾结石的有效性及安全性。方法:自2012年3月~2013年6月采用微创经皮肾镜联合组合式输尿管软镜处理鹿角形肾结石患者16例,其中完全性鹿角形结石3例,不完全性鹿角结石13例。结果:所有患者均采用单通道碎石,1例因术中出血,输尿管软镜无法有效碎石,改行二期顺行输尿管软镜钬激光碎石,余15例患者一期联合组合式输尿管软镜成功处理残留结石。平均手术时间(117.5±15)min,一期结石清除率为97.6%(15/16)。术中未出现大出血、尿源性脓毒血症、肠道损伤、胸膜损伤等严重并发症。结论:微创经皮肾镜联合组合式输尿管软镜治疗复杂性肾结石安全有效,在熟练掌握手术操作的前提下可以明显减少并发症,值得临床推广。     

泌尿外科

肾脏、输尿管：输尿管镜气压弹道碎石术与ESWL治疗输尿管结石的疗效比较；微创经皮肾镜取石术治疗小儿复杂性肾结石；钬激光碎石术治疗输尿管结石；微创经皮肾镜取石术治疗鹿角状结石；采用微创经皮肾穿刺输尿管镜碎石取石术治疗复杂性上尿路结石……     

经皮肾输尿管镜取石术治疗复杂肾结石20例

目的探讨复杂肾结石的微创治疗方法。方法经皮肾穿刺造瘘,输尿管镜通过造瘘通道,气压弹道碎石取石。结果手术全部成功,Ⅰ期取石12例,Ⅱ期取石8例,结石取尽率85%。结论微创经皮肾输尿管镜取石术是一种安全、可靠的治疗复杂性肾结石的方法。     

经皮肾镜取石术联合输尿管软镜钬激光碎石治疗复杂性肾结石临床分析

目的探讨经皮肾镜取石术联合输尿管软镜钬激光碎石治疗复杂性肾结石的临床效果。方法回顾性分析2018-10—2020-07间禹州市人民医院收治的60例复杂性肾结石患者的临床资料。根据治疗方法分为经皮肾镜取石术组(对照组)和联合输尿管软镜钬激光碎石术组(观察组),每组30例。比较2组患者的基线资料、手术和住院时间、一次性结石清除情况,以及并发症发生率。结果2组患者的基线资料差异无统计学意义(P>0.05)。观察组手术及住院时间均明显短于对照组,一次结石成功清除率高于对照组,并发症发生率低于对照组,差异均有统计学意义(P<0.05)。结论经皮肾镜取石术联合输尿管软镜钬激光碎石治疗复杂性肾结石,一次结石清除率高,术后并发症少,效果肯定。     

A retrospective analysis on the effect of single-channel minimally invasive percutaneous nephrolithotomy combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions to treat complex kidney stones

BackgroundSome types of complex kidney stones cannot be broken down and removed through single-channel percutaneous nephroscope or retrograde flexible ureteroscope. In order to be removed, these types of stones require multiple combined methods to be performed. The aim of this study was to retrospectively evaluate the clinical effect of single-channel minimally invasive percutaneous nephrolithotomy (mPCNL) combined with retrograde flexible ureteroscopy using the completely lateral decubitus and semi-lithotomy positions for treating complex renal calculi.MethodsWe selected 117 patients with complex renal calculi who were admitted to Peking University Shougang Hospital and Weifang People’s Hospital from January 1, 2017, to January 31, 2021. All patients were treated with single-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions. During the operation, the patients were placed in a completely lateral decubitus position, or their lower limbs were placed in a semi-lithotomy position for a single attempt only.ResultsAn 18-Fr percutaneous channel was successfully established in all patients. The mean operation time was 112±37 minutes, and the average blood loss was 71±31 mL. A 14-Fr renal fistula was maintained for 7 days, a urethral catheter for 2–3 days, and a ureteral stent tube for 2 weeks after each surgery. According to the results of computed tomography (CT) scans performed 3–5 days after the operation, the total lithotripsy success rate reached 100%, with a first-stage lithotripsy rate of 98.29%. Two patients were found to each have 1 residual stone, with a diameter of 4 mm, left in kidney by CT, which then was to be removed under local anesthesia. The average postoperative hospitalized time was 7±2 days, and no severe complications occurred perioperatively.ConclusionsSingle-channel mPCNL combined with retrograde flexible ureteroscopy in the completely lateral decubitus and semi-lithotomy positions is a safe, feasible, and highly effective method of treating complex renal calculi, which is of benefit to save operation time and facilitate operation process, because patient’s position could not need to be changed repeatedly during the surgery.     

Staged single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney

The aim of this study was to evaluate the outcome of staged single-tract minimally invasive percutaneous nephrolithotomy (MPCNL) and flexible ureteroscopy as a minimally invasive option in the treatment of staghorn stone in patients with a solitary kidney. A total of 24 patients with staghorn stone in a solitary kidney were treated with single-tract MPCNL and flexible ureteroscopy by a single surgeon. All the patients underwent single-tract MPCNL through a 20 F tract and had most of the intrarenal calculi removed at the first stage. The second stage of retrograde flexible ureteroscopy was performed 3–5?days later, after the drainage was cleared. The preoperative patient, characteristics, stone size, operative time, renal functional status and postoperative outcomes were then evaluated. Sixteen patients were partial staghorn (66.7?%), and other eight were complete staghorn (33.3?%). The overall stone-free rate was 83.3?% after the second-stage procedures, and only four patients had significant residue. The hemoglobin drop ranged from 1.1 to 3.7?g/dl, and three patients required blood transfusion. The mean serum creatinine value was 1.7?±?0.5?mg/dl before surgery and 1.3?±?0.4?mg/dl at the end of the follow-up period with statistical significance (P?<?0.05). None of the patients had increased serum creatinine, and needed dialysis at the end of the follow-up period. Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of staghorn stone in patients with a solitary kidney and even in patients with impaired renal functions.     

逆行经硬性软性输尿管镜下钬激光治疗60岁以上老年患者完全性鹿角形肾结石11例分析

目的 报道逆行经硬性软性输尿管镜下钬激光治疗60岁以上老年患者完全性鹿角形肾结石的经验并评价其效果。方法 本院2012年1月一2013年5月治疗11例老年单侧完全性鹿角形肾结石患者,年龄60~77岁,平均 67±7.2岁。11例主诉为严重肉眼血尿。术前留置7Fr Bard 输尿管支架1周。术中首先应用Olympus 8/9Fr硬性输尿管镜和科医人100+W钬激光机粉碎视野内结石部分,然后换成7.9Fr软性输尿管镜粉碎剩余结石,手术时间控制在120分钟内。术后常规留置7Fr D-J管3个月。术后3个月末查KUB评估结石排净率,仍残留较大结石的,行第二次手术碎石。结果 本组11例均安全经受手术,手术成功率100%。硬性软性输尿管镜一期碎石取石成功1例,10例需两次手术碎石,两次手术总净石率为10/11(90.9%)。未发生手术并发症。结论 逆行交替应用硬性软性输尿管镜联合钬激光治疗完全性鹿角形肾结石对60岁以上患者心血管循环系统影响小,净石率高,并发症少,也易于被患者接受,可作为治疗老年患者完全性鹿角形肾结石的首选术式之一。     

微创经皮肾取石术结合软式输尿管镜治疗肾鹿角形结石34例报告

目的:探讨微创经皮肾取石术(mPCNL)结合软式输尿管镜治疗肾鹿角形结石的临床疗效。方法:回顾分析2010年1月～2011年1月应用mPCNL结合软式输尿管镜治疗肾鹿角形结石患者34例,所有患者均行F18通道取石,其中单通道19例,双通道15例。结果:34例患者,19例单通道一期和分期mPCNL共26次;15例双通道一期和分期mPCNL共21次。平均手术时间130min;平均失血量120ml,4例需要输血,1例术后大出血,行超选择性肾动脉栓塞术。结石清除率85.3%(29/34)。结论:微创经皮肾取石术结合软式输尿管镜可减少穿刺通道和增加结石清除率。     

微通道经皮肾镜碎石术与输尿管软镜碎石术在治疗输尿管上段结石方面的临床研究

目的 探讨输尿管软镜碎石术（F-URL）与微通道经皮肾镜碎石术治疗输尿管上段结石的疗效对比。方法 2011年1月-2014年3,选取我院对输尿管上段结石（直径>1.5cm）的患者行微通道经皮肾镜碎石术（70例）和输尿管软镜碎石术（50例）,共120例。其中轻中度肾积水68例,重度积水52例。比较各组的术后住院时间、并发症数、一次性清石率、术前术后血红蛋白降幅及手术时间等方面的差异。结果 对120例患者进行统计分析,其中F-URL与mPCNL组的术后一次性结石清除率比较,P>0.05;在120例患者中F-URL比mPCNL术后平均住院时间短,P<0.05。F-URL比mPCNL在轻中度肾积水组术前术后血红蛋白降幅小,P<0.05;F-URL与mPCNL在重度肾积水患者中术前术后血红蛋白降幅基本一致,P>0.05。F-URL比mPCNL在轻中度肾积水组手术时间短,P<0.05;F-URL比mPCNL在重度肾积水组手术时间长,P<0.05。 结论 F-URL和mPCNL均为治疗输尿管上段结石的安全、有效治疗方法;F-URL对输尿管上段结石并轻中度肾积水的病人是一种安全有效的治疗方式;mPCNL对输尿管上段结石并重度肾积水的病人是首要选择之一。     

同期输尿管软镜钬激光碎石术治疗双侧上尿路结石

目的评价同期行双侧上尿路结石输尿管软镜碎石术治疗的安全性和疗效。 方法回顾分析2017年2月至2019年7月我院行同期输尿管软镜钬激光碎石术治疗双侧上尿路结石患者的临床资料。分析了手术时间、结石清除率及并发症发生情况等,复查无残石或结石残块<4 mm视为碎石成功。 结果共纳入33例患者（男26例,女7例）,平均年龄（42±13）岁。结石总负荷为（3.48±1.11） cm,手术时间为（89±36） min,第一次和第二次手术后结石清除率分别为69.7%和81.8%。7例（21.2%）患者出现轻微并发症（Clavien-Dindo Ⅰ-Ⅱ级）,2例（6%）出现较严重并发症（Clavien-Dindo Ⅲ级）。 结论输尿管软镜钬激光碎石术同期治疗双侧上尿路结石安全有效。     

Is antegrade ureteroscopy better than retrograde ureteroscopy for impacted large upper ureteral calculi?

OBJECTIVE: This study was planned to compare the risks and advantages of antegrade and retrograde ureteroscopy for impacted large upper ureteral calculi. PATIENTS AND METHODS: From September 1996 to February 1998, ureteroscopy was offered to 43 patients. Of these, retrograde ureteroscopy was done in 20 patients, while antegrade ureteroscopy was performed in 23 patients. All these patients were followed up to evaluate the immediate and long-term success of the procedure. The incidence and nature of complications were also noted. RESULTS: During retrograde ureteroscopy, complete stone clearance was achieved in 11 patients (55%), while pushback of the whole or fragmented calculus was seen in the rest. These patients with residual calculi were later treated by extracorporeal shockwave lithotripsy (SWL). The stone-free rate at the end of 3 months was 85%. Three patients developed minor ureteroscopy-related complications. Complete stone clearance was achieved in all patients with antegrade ureteroscopy. No intraoperative or postoperative complications were encountered. CONCLUSION: In this series, antegrade ureteroscopy was found to be a safe and effective option for impacted upper ureteral calculi and assured better results than retrograde ureteroscopy.     

Successful outcome of flexible ureteroscopy with holmium laser lithotripsy for renal stones 2 cm or greater

Although percutaneous nephrolithotomy has been recommended as the first-line treatment for renal stones larger than 2 cm, its major complication rate is not negligible and less invasive approaches are to be explored. Thanks to the recent advances in endoscopic technology, flexible ureteroscopy has become another option in this setting. Herein we report our most recent experience with flexible ureteroscopy for large renal stones. Between September 2008 and May 2011, 20 patients with renal stones ≥ 2 cm underwent a total of 28 procedures of ureteroscopy with holmium laser lithotripsy, using the Olympus URF-P5 and a ureteral access sheath. The number of procedures, operative time, stone-free rates, stone compositions and complications were evaluated. Stone-free status was defined as the absence of fragments or fragments of ≤ 4 mm. Mean stone size was 3.1 cm (range 2.0-5.0). The average number of procedures was 1.4. One, two and three procedures were required in 13, six and one patients, respectively. Overall, the stone-free rate was 90%. The stone-free rate for preoperative stone size of 2 to ≤ 4 cm and >4 cm was 100% (14/14) and 67% (4/6), respectively. No major intraoperative complications were identified. Postoperative high-grade fever was observed in three patients, including one patient who developed sepsis. All these patients were successfully treated conservatively. Our findings suggest that ureteroscopy represents a favorable option for selected patients with renal stones, especially those 2 to ≤ 4 cm in size.     

Flexible ureteroscopy and holmium laser lithotripsy for treatment of upper urinary tract calculi in patients with autosomal dominant polycystic kidney disease

The objective of the study was to investigate the safety and efficacy of flexible ureteroscopy and holmium laser lithotripsy for the management of patients with autosomal dominant polycystic kidney disease (ADPKD) and associated nephrolithiasis. Between 2005 and 2010, flexible ureteroscopic stone treatment was attempted in 13 patients with ADPKD. Two patients had bilateral renal stones. Most of the stones were located in the renal pelvis and/or calices with a stone size 1.7 cm in the largest diameter. The success rate and morbidity and complications were recorded. A total of 45 intrarenal calculi with a mean stone size of 5.6 mm (range 3–17) were identified. The mean number of stones per patients was 3.2 (range 2–5). The mean number of primary procedures was 1.2 (range 1–2). The overall stone-free rates after one and two procedures were 84.5 and 92.3%, respectively. Complications occurred in three procedures and consisted of low-grade fever in one procedure, flank pain in another procedure and stent pain in another procedure. No patient died. Flexible ureteroscopy with holmium laser lithotripsy is a safe and effective method for the treatment of patients with ADPKD and associated nephrolithiasis.