改良负压吸引经皮肾镜钬激光碎石71例报告

目的探讨改良负压吸引经皮肾镜钬激光碎石的方法及可行性。方法2007年1月至2008年12月，我院采用改良负压吸引经皮肾镜钬激光碎石治疗。肾结石71例，其中单发肾结石37例，多发肾结石34例，鹿角状结石11例，结石直径2．0～6．1cm，平均2．4cm。记录碎石取石时间、结石取净率以及手术并发症。结果术中碎石取石时间30～120min，平均56min，一次经皮肾镜取石术结石取尽率为70％（50，71），总取尽率89％（63／71）。术中术后出血需输血7例，术后感染发热6例，无其它严重并发症。结论改良负压吸引经皮肾镜钬激光碎石术中可促进碎石的排出，提高碎石取石效率，缩短手术取石时间，同时负压吸引可减少肾盂内高压灌注液和细菌毒素的吸收，增加手术安全性。

Improvement to Holmium laser with percutaneous nephrolithotripsy (report of 71 cases)

Objective To explore the improvement and effectiveness of holmium laser with pereutaneous nephrolithotripsy, Methods We established 24F-27F percutaneous lithotomy channels by ultrasonic positioning, and used WOLF nephroscope with 18.5F sheath to draw water reversely from outside sheath. After connecting nephroscope to negative pressure suction, we then used 5F hard metal tube with a length of 40 mm to direct holmium laser fiber. From January 2007 to December 2008, we used the holmium laser with percutaneous nephrolithotripsy to treat 71 patients with kidney stones, in which 37 patients were with single stones, 34 with multiple renal calculi, and 11 with staghorn stones. In the meanwhile, we recorded stone surgery durations, stone-free rates and complications as well. No severe complications were occurred. Results Each time a stone surgery was done within 30-120mins, and with 56 mins in average. The stonefree rate was 70% （50/71） for the first session, and up to 89% （63/71） for the last session. Postoperative bleeding was found on 7 patients, and postoperative pyrexia were observed on 6 patients. Conclusions The improvement to the operation method can faciliate stone discharge, shorten survey duration, and can offset the disadvantages experienced with the holmium laser lithotripsy. It can also reduce the likelihood of complication resulted from high pressure built up within kidneys. In summary, it is a effective improvement.