标准通道经皮肾镜钬激光碎石取石术联合微通道技术治疗复杂性肾结石的临床疗效观察
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摘要
目的评价标准通道经皮肾镜钬激光碎石取石术联合微通道技术治疗复杂性肾结石的安全性和临床疗效。方法采用标准通道联合微通道(F22+F16)经皮肾镜钬激光碎石取石治疗的复杂性肾结石病人90例,对手术时间、术中出血量、一期结石清除率和手术并发症等指标进行分析。结果 90例病人中共81例病人行一期标准通道联合微通道经皮肾镜钬激光碎石取石,术中出血量为(94. 71±20. 58) ml,一期总体清石率达为91. 11%,出现术后并发症9例,对症处理后均治愈(仅1例迟发性出血行介入栓塞治疗)。结论标准通道经皮肾镜钬激光碎石取石术联合微通道技术治疗复杂性肾结石净石率高、并发症低,治疗复杂性肾结石可行,安全有效。
Objective To evaluate the safety and clinical efficacy of standard transcutaneous holmium laser lithotripsy combined with microchannel technique in the treatment of complicated renal calculi. Methods Retrospective analysis of 90 cases of complex kidney stones in patients with clinical data in our hospital with a standard channel joint microchannel( F22 + F16) percutaneous nephroscope holmium laser lithotrips,and the operation time,intraoperative blood loss,the first phase of stone clearance rates and complications such as indicators for analysis. Results 81 cases were treated with stage Ⅰ standard channel joint microchannel percutaneous nephroscope holmium laser combined with microchannel technology,intraoperative blood loss was( 94. 71 ± 20. 58) ml,the overall stone removal rate of stage Ⅰ reached 91. 11%,and the postoperative complications were 9 times in total,which were cured after treatment.( Only 1 case of delayed hemorrhages line interventional embolization). Conclusion Standard transcutaneous transcutaneous holmium laser lithotripsy combined with microchannel technology for complicated renal calculi has the advantages of high net stone rate and low complications,which can be used as a feasible,safe and effective surgical method for complicated renal calculi.
Objective To evaluate the safety and clinical efficacy of standard transcutaneous holmium laser lithotripsy combined with microchannel technique in the treatment of complicated renal calculi. Methods Retrospective analysis of 90 cases of complex kidney stones in patients with clinical data in our hospital with a standard channel joint microchannel( F22 + F16) percutaneous nephroscope holmium laser lithotrips,and the operation time,intraoperative blood loss,the first phase of stone clearance rates and complications such as indicators for analysis. Results 81 cases were treated with stage Ⅰ standard channel joint microchannel percutaneous nephroscope holmium laser combined with microchannel technology,intraoperative blood loss was( 94. 71 ± 20. 58) ml,the overall stone removal rate of stage Ⅰ reached 91. 11%,and the postoperative complications were 9 times in total,which were cured after treatment.( Only 1 case of delayed hemorrhages line interventional embolization). Conclusion Standard transcutaneous transcutaneous holmium laser lithotripsy combined with microchannel technology for complicated renal calculi has the advantages of high net stone rate and low complications,which can be used as a feasible,safe and effective surgical method for complicated renal calculi.
引文
[1]曹武军,张孝斌,张杰.复杂性肾结石的外科治疗进展[J].国际泌尿系统杂志,2000,20(s1):164-165.
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[6]周盛涛.微通道与标准通道经皮肾镜钬激光碎石取石术治疗肾结石的疗效观察[J].中国现代药物应用,2016,10(15):68-70.
[7]Desai M,Mishra S.'Microperc'micro percutaneous nephrolithotomy:evidence to practice[J].Curr Opin Urol,2012,22(2):134-138.
[8]Johri N,Cooper B,Robertson W,et al.An update and practical guide to renal stone management[J].Nephron Clin Pract,2010,116(3):c159-171.
[9]Elnahas AR,Shokeir AA,Shoma AM,et al.Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients[J].Can Urol Assoc J,2014,8(11-12):E906-909.
[10]Kim BS.Recent advancement or less invasive treatment of percutaneous nephrolithotomy[J].Korean J Urol,2015,56(9):614-623.
[11]Hatipoglu NK,Tepeler A,Buldu I,et al.Initial experience of micropercutaneous nephrolithotomy in the treatment of renal calculi in 140renal units[J].Urolithiasis,2014,42(2):159-164.
[12]Sakr A,Salem E,Kamel M,et al.Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position:single-center experience[J].Urolithiasis,2017,45(2):1-5.
[13]Liang T,Zhao C,Wu G,et al.Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones:our experience[J].BMC Urol,2017,17(1):15.
[14]Akman T,Sari E,Binbay M,et al.Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses[J].J Endourol,2010,24(6):955-960.
[15]匡小根,曹友汉,蔡晓健,等.输尿管软镜下钬激光碎石术治疗重复肾结石的临床分析[J].中南医学科学杂志,2015,43(2):183-185.
[16]Zeng G,Zhu W,Li J,et al.The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney:a matched-pair analysis[J].World J Urol,2014,33(8):1159-1164.
[2]Bucuras V,Gopalakrishnam G,Jr WJ,et al.The Clinical Research Office of the Endourological Society Percutaneous Nephrolithotomy Global Study:nephrolithotomy in 189 patients with solitary kidneys[J].JEndourol,2011,25(8):1263-1268.
[3]Shi X,Peng Y,Li X,et al.Propensity-score matched analysis comparing retrograde intrarenal surgery with percutaneous nephrolithotomy for large stones in patients with a solitary kidney[J].J Endourol,2018,32(3):198-204.
[4]张军卫,龚晋迁,彭东涛,等.Fr26通道经皮肾镜治疗复杂性肾结石257例[J].中国微创外科杂志,2015,15(3):232-234.
[5]Ramakumar S,Segura JW.Renal calculi.Percutaneous management[J].Urol Clin North Am,2000,27(4):617-622.
[6]周盛涛.微通道与标准通道经皮肾镜钬激光碎石取石术治疗肾结石的疗效观察[J].中国现代药物应用,2016,10(15):68-70.
[7]Desai M,Mishra S.'Microperc'micro percutaneous nephrolithotomy:evidence to practice[J].Curr Opin Urol,2012,22(2):134-138.
[8]Johri N,Cooper B,Robertson W,et al.An update and practical guide to renal stone management[J].Nephron Clin Pract,2010,116(3):c159-171.
[9]Elnahas AR,Shokeir AA,Shoma AM,et al.Percutaneous nephrolithotomy versus open surgery for treatment of staghorn stones in pediatric patients[J].Can Urol Assoc J,2014,8(11-12):E906-909.
[10]Kim BS.Recent advancement or less invasive treatment of percutaneous nephrolithotomy[J].Korean J Urol,2015,56(9):614-623.
[11]Hatipoglu NK,Tepeler A,Buldu I,et al.Initial experience of micropercutaneous nephrolithotomy in the treatment of renal calculi in 140renal units[J].Urolithiasis,2014,42(2):159-164.
[12]Sakr A,Salem E,Kamel M,et al.Minimally invasive percutaneous nephrolithotomy vs standard PCNL for management of renal stones in the flank-free modified supine position:single-center experience[J].Urolithiasis,2017,45(2):1-5.
[13]Liang T,Zhao C,Wu G,et al.Multi-tract percutaneous nephrolithotomy combined with EMS lithotripsy for bilateral complex renal stones:our experience[J].BMC Urol,2017,17(1):15.
[14]Akman T,Sari E,Binbay M,et al.Comparison of outcomes after percutaneous nephrolithotomy of staghorn calculi in those with single and multiple accesses[J].J Endourol,2010,24(6):955-960.
[15]匡小根,曹友汉,蔡晓健,等.输尿管软镜下钬激光碎石术治疗重复肾结石的临床分析[J].中南医学科学杂志,2015,43(2):183-185.
[16]Zeng G,Zhu W,Li J,et al.The comparison of minimally invasive percutaneous nephrolithotomy and retrograde intrarenal surgery for stones larger than 2 cm in patients with a solitary kidney:a matched-pair analysis[J].World J Urol,2014,33(8):1159-1164.