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。

Single-tract minimally invasive percutaneous nephrolithotomy and staged flexible ureteroscopy in the treatment of complicacy kidney stone

Objective:To evaluate the efficacy and safety of staged single-tract minimally invasive percutaneous nephrolithotomy(MPCNL) and flexible ureteroscopy in the treatment of complicacy kidney stone.Methods:From Jan 2011 to Feb 2012,a total of 79 patients with complicacy kidney stone were treated with single-tract minimally invasive percutaneous nephrolithotomy and flexible ureteroscopy by a single surgeon.Twenty five patients were staghorn(31.6%),and the others were multiple kidney stone(68.4%).All patients underwent single-tract MPCNL through a F20 tract and had most of the intrarenal calculi removed at the first stage.The second stage of retrograde flexible ureteroscopy was performed three to five days later after the drainage was cleared.The preoperative patient,characteristics,stone size,operative time and postoperative outcomes were then evaluated.Results:All operation were successful and no major complications were noted in all patients.The average operation time was(85±16) minutes at first stage and(46±21) minutes at second stage.The overall stone-free rate was 92.4% after the second-stage procedures and only six patients had significant residue.Conclusions:Staged single-tract MPCNL and flexible ureteroscopy are safe and effective for the management of complicacy kidney stone.