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目的:探讨微创经皮肾镜取石术一期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:自2012年1月～2012年7月采用微创经皮肾镜取石术一期联合逆行输尿管软镜治疗铸型肾结石患者38例,其中完全性铸型结石患者15例,不完全性铸型结石患者23例,结石直径2.3～4.7cm。结果:所有手术均成功建立工作通道并一期碎石取石,其中单通道取石31例,双通道取石7例。2例因术中出血,输尿管软镜镜下无法有效碎石,改用二期逆行输尿管软镜取石术取尽结石,余36例患者一期联合输尿管软镜均探及残留结石并采用钬激光碎石治疗。平均手术时间(51±18)min,结石清除率为94.7%(36/38)。未出现气胸、肠道损伤、大出血或尿源性脓毒血症等严重并发症。结论:微创经皮肾镜取石术一期联合逆行输尿管软镜治疗铸型肾结石安全、有效,值得临床推广。
Objective: To investigate the effectiveness and safety of minimally invasive percutaneous nephrolithotomy combined with retrograde ureteroscopy in the treatment of complex renal calculus. Methods: From January 2012 to July 2012, 38 patients with renal calculi were treated by minimally invasive percutaneous nephrolithotomy combined with retrograde ureteroscopic soft-lensing. Among them, 15 patients with complete mold stone were incomplete. Twenty-three cases of stone patients with stone diameter of 2.3 ~ 4.7cm. Results: All operations were successfully established working channel and a lithotripsy, including single-channel stone in 31 cases, double-channel stone in 7 cases. 2 cases due to intraoperative bleeding, ureteroscopic soft lens can not be effective lithotripsy, switch to the second retrograde ureteroscopic lithotomy stone, more than 36 cases of a ureteroscopy and residual stones were detected and the use of holmium laser Gravel treatment. The average operation time (51 ± 18) min, stone clearance rate was 94.7% (36/38). No severe complications such as pneumothorax, intestinal damage, major bleeding or urinary sepsis occurred. Conclusion: The minimally invasive percutaneous nephrolithotomy combined with retrograde ureteroscopy in the treatment of cast renal stones is safe and effective, which is worthy of clinical promotion.