标准通道经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石临床分析

目的：探讨标准通道经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的可行性与临床疗效。方法回顾分析我院2011年1月~2013年12月收治46例复杂性肾结石患者的临床资料：完全性铸型结石、鹿角形结石27例，不完全性、多发结石19例，结石直径2.6~4.5cm。34例有肾集合系统分离，分离程度1.5~6.5cm。5例曾行肾、输尿管开放手术取石术，术后结石复发。采用标准通道经皮肾镜联合输尿管软镜同期、分期碎石取石进行治疗。结果本组46例患者均成功建立标准通道并一期碎石取石。同期手术33例，分期手术13例，其中术中因出血，患者年龄较大，结石较大、较硬，肾镜下碎石时间较长，输尿管狭窄等原因，术中决定更改分期手术7例。本组结石清除率91.3%（42/46），均未出现大出血、邻近脏器损伤、术后严重感染等并发症。结论标准通道经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石，临床效果较好、手术创伤较小、术后恢复好，是一种安全、有效的方法。

The clinical analysis of complicated kidney stone treated with standard channel percutaneous nephroscope jointed flexi-ble ureteroscope at the same period operation and staging operation

Objective To explore the feasibility and clinical efficacy of kidney stones patients treated with standard channel percutaneous nephroscope jointed flexible ureteroscope at the same period operation and staging operation. Methods Retrospectively analyzed the clinical data of 46 patients with complicated kidney stone from Jan 2011 to Dec 2013. 27 cases had complete cast or staghorn calculi stones, 19 cases had incomplete or multiple stones,the diameter of stone was 2.6~4.5cm. 34 cases had renal collecting system separation,the separation degree was 1.5~6.5cm. 5 cases had ever had renal and ureter stone extraction for open surgery, postoperative recurrence of stones. With a standard channel percutaneous nephroscope jointed flexi-ble ureteroscope at the same period operation and staging operation , installment of gravel lithotomy for treatment. Results 46 patients of this group were successfully established standard channel and issue of rubble stone. 13 cases took staging operation and 33 cases took the same period operation during this period, 7 cases changed to take staging operation because of intraopera-tive bleeding, age, the size and hardness of the stone, the long time of nephroscope lithotripsy, ureteral stricture. The stone clearance rate was 91.3% （42/46）, no bleeding, no adjacent viscera injury,no postoperative serious infection occured. Con-clusion Complicated kidney stone treated with standard channel percutaneous nephroscope jointed flexible ureteroscope at the same period operation and staging operation had better curative effect, less surgical trauma,better postoperative recovery. It is a safe and effective method.