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目的:探讨单通道一期经皮肾镜碎石联合顺行输尿管软镜处理残石治疗复杂性肾结石的临床疗效及安全性。方法:自2013年1月-2016年6月采用单通道一期经皮肾镜碎石术联合顺行组合式输尿管软镜处理残石治疗复杂性肾结石83例,其中多发肾结石51例,鹿角形肾结石32例。结果:4例因术中出血,输尿管软镜下视野欠清,无法有效碎石,改行二期顺行输尿管软镜碎石,余79例患者均顺利完成经皮肾镜碎石联合顺行组合式输尿管软镜处理残石,平均手术时间(137.7±23.6)min,一期结石清除率为91.6%(76/83)。术中未出现大出血、尿脓毒血症、结肠损伤、胸膜损伤等严重并发症。结论:单通道一期经皮肾镜碎石联合顺行输尿管软镜处理残石治疗复杂性肾结石疗效确切,安全可靠,是提高结石清除率的有效办法,值得临床推广使用。
Objective: To investigate the clinical efficacy and safety of single-channel percutaneous nephrolithotomy combined with anterograde ureteroscopic treatment of complex stone of kidney stones. Methods: From January 2013 to June 2016, 83 cases of complex renal calculus were treated with single-channel percutaneous nephrolithotomy and cisplatin ureteroscopic treatment of refractory stone, of which 51 cases were multiple nephrolithiasis, Antler kidney stones in 32 cases. Results: In 4 cases, due to intraoperative bleeding, ureteral soft lens under the field of vision was clear, unable to effectively lithotripsy, diverted to the second phase of anterograde ureteroscopic soft lithotripsy, more than 79 patients were successfully completed percutaneous nephrolithotomy combined with cis-combination Ureteroscopic treatment of residual stones, the average operation time (137.7 ± 23.6) min, a stone clearance rate of 91.6% (76/83). Intraoperative bleeding did not occur, urinary sepsis, colon injury, pleural injury and other serious complications. Conclusions: Single-stage percutaneous nephrolithotomy combined with anterograde ureteroscopic treatment of residual stones in the treatment of complex renal stones is effective, safe and reliable, which is an effective way to improve the rate of stone removal. It is worth to be used clinically.