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目的:总结mPCNL联合输尿管镜钬激光碎石术治疗复杂性同侧肾输尿管多部位结石的方法、疗效及并发症,探讨临床应用价值。方法:回顾性分析mPCNL联合输尿管镜钬激光碎石术治疗73例复杂性同侧肾输尿管多部位结石患者的临床资料,男42例,女31例,年龄20～65岁,平均42岁,术前经B超、KUB与IVU、RUP或CT确诊。肾结石横径1.0～3.4cm,纵径1.8～4.2cm,输尿管结石横径0.5～1.2cm,纵径1.0～3.0cm,为同侧多部位存在,9例合并有对侧无积水肾结石。输尿管结石位于中下段的52例,上段的21例;并发肾积水73例,轻度47例,中度20例,重度6例。结果:73例手术均成功,患者全部治愈。所有的输尿管结石均一期取净。肾结石患者中一期取净结石59例,结石取净率达81%。9例残余<3mm位于肾盏内的小结石,未进行进一步处理。二期手术5例。术后发生全身炎症反应综合症3例,经抗感染对症药物治疗后治愈。肾周积液感染2例,B超定位下行穿刺引流后行细菌培养+药物敏感试验,选用敏感抗生素抗感染治疗痊愈。术中较大出血2例,输血并用气囊管压迫止血治愈。平均住院14d。无因并发症导致肾切除,无输尿管穿孔,无腹内脏器损伤,无中转开放手术,无死亡病例。结论:mPCNL联合输尿管镜钬激光碎石术治疗复杂性同侧肾输尿管多部位结石既逆行处理了输尿管结石,又确切地留置输尿管导管至肾盂,有利于人工肾积水形成经皮肾通道的建立,同时也减少了肾实质撕裂出血风险,显示出安全、创伤少、碎石清石率高、效果满意等优点
OBJECTIVE: To summarize the methods, curative effects and complications of mPCNL and ureteroscopic holmium laser lithotripsy in the treatment of complex ipsilateral renal ureteral calculi and explore its clinical value. Methods: A retrospective analysis of mPCNL combined with ureteroscopic holmium laser lithotripsy in 73 patients with complicated ipsilateral kidney ureteral calculi in multiple clinical data, 42 males and 31 females, aged 20 to 65 years, mean 42 years, surgery Before B ultrasound, KUB and IVU, RUP or CT confirmed. The diameter of renal calculi 1.0 ~ 3.4cm, longitudinal diameter 1.8 ~ 4.2cm, diameter of ureteral stones 0.5 ~ 1.2cm, longitudinal diameter 1.0 ~ 3.0cm, there are multiple sites for the same side, 9 cases with contralateral hydronephelus . Ureteral calculi in the middle and lower segments of the 52 cases, the upper 21 cases; 73 cases of hydronephrosis, mild in 47 cases, moderate in 20 cases, severe in 6 cases. Results: All 73 cases were successful and all patients were cured. All of the ureteral stones to take a net period. 59 cases of nephrolithiasis in a period of net stones, stone take rate of 81%. 9 cases of residual <3mm small calyx in calyces, without further treatment. Two cases of surgery in 5 cases. Postoperative systemic inflammatory response syndrome occurred in 3 cases, cured by anti-infective symptomatic drug treatment. Peritoneal effusion infection in 2 cases, B-positioning down after puncture and drainage bacterial culture + drug sensitivity test, the selection of sensitive antibiotics anti-infective cure. Intraoperative bleeding in 2 cases, blood transfusion and balloon hemostasis. The average hospital 14d. No complications caused by nephrectomy, no ureter perforation, no abdominal organ damage, no transit open surgery, no deaths. Conclusion: The combination of mPCNL and ureteroscopic holmium laser lithotripsy in the treatment of complex ipsilateral renal urethral multiple site calculi not only retrograde ureteral calculi, but also extubation of the ureter directly to the renal pelvis is beneficial to the establishment of percutaneous renal channels , While also reducing the risk of renal parenchymal tearing and bleeding, showing safety, less trauma, gravel clear rate, satisfactory results