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。

Percutaneous nephrolithotomy combined with flexible ureteroscope via single renal channel for the treatment of renal staghorn calculi

ObjectiveTo evaluate the efficacy of percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel in the treatment of renal staghorn calculi. MethodsData of 37 cases of renal staghorn calculi treated by percutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel from January 2014 to August 2016 were analyzed retrospectively.There were 14 males and 23 females. Age ranged from 34 to 62 years with a mean of 46 years. The stones in 25 cases were located on the left side, 12 cases on the right side. The diameter of stones was between 3.3 cm to 6.0 cm, average (4.9±0.1) cm. All patients underwent single channel percutaneous nephrolithotomy combined with flexible ureteroscope under the guidance of ultrasound, using EMS and holmium laser fragment stones, and the channel of puncture was expanded to 20 F. ResultsThirty-seven cases were set single 20 F renal channel and 36 cases were treated by percutaneous nephrolithotomy combined with flexible ureteroscope in one-stage. Single renal channels were set at the subrenal calyx in 34 cases (91.9%). The stone clearance rate in the first stage was 86.5%(32/37)and operation time was between 58 to 125 min with an average of (92±23) min. Postoperative hemoglobin decreased 3.2~9.5 g/L with an average of (5.7±1.8) g/L. The postoperative hospitalization time was 5 to 9 days with an average of (7±1) days. Three patients suffered from fever on surgery day, the body temperature was over 38.5℃. No renal perforation, hydrothorax, seroperitoneum, hemorrhoea and blood transfusion occurred. ConclusionPercutaneous nephrolithotomy combined with flexible ureteroscope via single 20 F renal channel has high stone clearance rate, mini-invasion and less operative time in the treatment of renal staghorn calculi.