经皮肾镜取石术联合输尿管软镜治疗孤立肾复杂结石

目的观察一期经皮肾镜取石术(PCNL)联合二期输尿管软镜手术(RIRS)治疗孤立肾复杂性结石的临床疗效观察。方法回顾分析我科收治的64例孤立肾复杂性结石患者,随机分为观察组和对照组,每组32例。观察组患者在全麻下行PCNL联合RIRS治疗。对照组患者在全麻下行PCNL治疗,术后残留结石者行体外冲击波碎石治疗(ESWL)。两组患者均于术后3个月复查KUB或B超评估结石清除率并评估肾功能恢复情况。结果两组患者经过治疗后均取得满意疗效,观察组患者治疗总有效率96.9%,明显高于对照组75.0%,差异具有统计学意义(P<0.05);两组患者治疗后血肌酐为均明显降低,观察组指标明显优于对照组(P<0.05);两组患者在手术总时间和并发症发生率方面未见明显差异(P>0.05)。结论一期PCNL联合二期RIRS治疗孤立肾复杂性结石疗效确切、结石清除率高,具有良好的安全性,值得临床推广。

Treatment of Complex Renal Stones in Solitary Kidneys Under Percutaneous Nephrolithotomy Combined with Retrograde Intrarenal Surgery

Objective To observe the clinical efficacy ofpercutaneous nephrolithotomy （PCNL） combined with retrograde intrarenal surgery （R/RS） to treat the complex renal stones in solitary kidneys. Methods 64 cases with complex renal stones in solitary kidneys were randomly divided into observation group and control group, with 32 patients each. The patients in observation group were treated by PCNL combined with R1RS. The control group was treated by PCNL and ESWL if needed. The stone clearance rate and renal function were observed 3 months after treatment by the KUB or B ultrasound. Results After the therapy, the two groups were significantly improved. The total effective rate in the observation group （96.9%） was significantly higher than the control group （75,0%）. The serum creatinine in the observation group reduced more than the control group （P 〈0.05）. The side effects had no difference between the two groups （P 〉0.05）. Conclusions PCNL combined with RIRS could be an effective and safe option for complex stones in solitary kidneys and is worthy of clinical application.