双镜联合治疗经皮肾镜术后平行通道残石
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摘要
目的探讨输尿管软镜、经皮肾镜双镜联合治疗与经皮肾镜通道平行的术后残石的安全性及有效性。方法回顾性分析100例经皮肾镜术后残石患者,残石(或部分残石)与Ⅰ期经皮肾穿刺手术通道平行,KUB或CT测量残石直径0.8～1.5cm,平均(1.30±0.17)cm。将患者随机分成对照组与实验组,对照组采用Ⅱ期经皮肾镜取石术,实验组采用输尿管软镜联合经皮肾镜术。结果残石清除率实验组显著高于对照组(92%vs 58%),差异有统计学意义(P <0.05)。结论输尿管软镜联合经皮肾镜术治疗经皮肾镜术后残石,高效、安全,对与经皮肾穿刺通道平行的残石尤为适用,值得推广。
Objective To investigate the safety and efficacy of postoperative residual stones with ureteroscopy and percutaneous nephrolithotomy combined with percutaneous nephrolithotomy. Methods One hundred patients with residual stone after percutaneous nephroscopy were analyzed retrospectively.Residual stone(or partial residual stone)was parallel to the primary percutaneous renal puncture channel.The diameter of residual stone was 0.8-1.5 cm by KUB or CT,with an average of(1.30±0.17)cm.The patients were randomly divided into two groups:the control group and the experimental group.The patients in the control group were treated with II stage percutaneous nephrolithotomy,and the experimental group were treated with soft ureteroscopy combined with percutaneous nephroscopy. Results The residual stone clearance rate in the experimental group was significantly higher than that in the control group(92% vs 58%), and the difference was statistically significant by χ2 test(P < 0.05). Conclusion Ureteroscopy combined with percutaneous nephrolithotomy for the treatment of residual stones after percutaneous nephrolithotomy is highly effective and safe.It is particularly suitable for the residual stone parallel to the percutaneous renal puncture passage and is worth popularizing.
Objective To investigate the safety and efficacy of postoperative residual stones with ureteroscopy and percutaneous nephrolithotomy combined with percutaneous nephrolithotomy. Methods One hundred patients with residual stone after percutaneous nephroscopy were analyzed retrospectively.Residual stone(or partial residual stone)was parallel to the primary percutaneous renal puncture channel.The diameter of residual stone was 0.8-1.5 cm by KUB or CT,with an average of(1.30±0.17)cm.The patients were randomly divided into two groups:the control group and the experimental group.The patients in the control group were treated with II stage percutaneous nephrolithotomy,and the experimental group were treated with soft ureteroscopy combined with percutaneous nephroscopy. Results The residual stone clearance rate in the experimental group was significantly higher than that in the control group(92% vs 58%), and the difference was statistically significant by χ2 test(P < 0.05). Conclusion Ureteroscopy combined with percutaneous nephrolithotomy for the treatment of residual stones after percutaneous nephrolithotomy is highly effective and safe.It is particularly suitable for the residual stone parallel to the percutaneous renal puncture passage and is worth popularizing.
引文
[1]那彦群,孙光,叶章群,等.中国泌尿外科学疾病诊断治疗指南手册[M].北京:人民卫生出版社,2009:176-177.
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[3]李逊,曾国华,袁坚,等.经皮肾穿刺取石术治疗上尿路结石(20年经验)[J].北京大学学报(医学版),2004,16(21):124-126.
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[5]徐刚,李忠义,张哲伟,等.电子输尿管软镜钬激光碎石治疗一期单通道经皮肾镜术后残石的安全性及疗效[J].中华腔镜泌尿外科杂志(电子版),2014,8(3):23-26.
[6]陈恕求,温海涛,陈明.输尿管软镜在上尿路疾病诊治中的应用(29例报告)[J].中国内镜杂志,2010,16(5):527-529.
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[9]Ferroud V,Lapouge O,Doussea A,et al.Flexible ureteroscopy and Mini Percutaneous nephrostolithotomy in the treatment of renal lithiasis or equal to 2cm[J].Prog Urol,2011,21(2):79-84.
[10]Guibin Xu,Xun Li,Youngzhong He,et al.Staged singletract minimally invasive Percutaneous nephrostolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney[J].Urological Research,2012,40(6):745-749.
[11]Friedlander JI,Duty BD,Smith AD,et al.Percutaneous nephrostolithotomy:an assessment of costs for prone and Galdakao-modified supine Valdivia postioning[J].Urology,2012,80(4):771-775.
[12]Mcaleer IM,Kaplan GW,Bradley JS,et al.Endotoxin content in renal calculi[J].J Urol,2003,169(5):1813-1814.
[13]Stamey T.Pathogenesis and treatment of urinary tract infections[M].Baltimore:Williams&Wilkins Co,1980:430-431.
[14]Levy MM,Artiagas A,Phillips GS,et al.Qutcomes of the surviving sepsis campaign in intensive care units in the USA and Europe:a prospective cohort study[J].LANCETInfectious Diseases,2012,12(12):919-924.
[15]郑府,杨嗣星,宋超,等.输尿管软镜碎石术中肾盂内压力监测[J].国际泌尿外科杂志,2014,34(3):339-343.
[2]Desai M,Jain P,Ganpule A,et al.Developments in technique and technology:the effect on the results of percutanous nephrolithotomy for staghorn calculi[J].BJUInt,2009,104(4):542-548.
[3]李逊,曾国华,袁坚,等.经皮肾穿刺取石术治疗上尿路结石(20年经验)[J].北京大学学报(医学版),2004,16(21):124-126.
[4]李淦洪,王亚东,罗文辉,等.体外冲击波碎石治疗经皮肾镜术后残石的时机选择及部分相关因素分析[J].中华腔镜泌尿外科杂志(电子版),2016,10(4):17-19.
[5]徐刚,李忠义,张哲伟,等.电子输尿管软镜钬激光碎石治疗一期单通道经皮肾镜术后残石的安全性及疗效[J].中华腔镜泌尿外科杂志(电子版),2014,8(3):23-26.
[6]陈恕求,温海涛,陈明.输尿管软镜在上尿路疾病诊治中的应用(29例报告)[J].中国内镜杂志,2010,16(5):527-529.
[7]Hussain M,Acher P,Penev B,et al.Redefining the limits of flexible ureterorenoscopy[J].J Endourol,2011,25(1):45-49.
[8]El-Nahas A R,Ibrahim H M,Youssef R F,et al.Flexible ureterorenoscopy versus extracorporeal shock wave lithotripsy for treatment of lower pole stones of 10-20mm[J].BJU int,2012,110(6):898-902.
[9]Ferroud V,Lapouge O,Doussea A,et al.Flexible ureteroscopy and Mini Percutaneous nephrostolithotomy in the treatment of renal lithiasis or equal to 2cm[J].Prog Urol,2011,21(2):79-84.
[10]Guibin Xu,Xun Li,Youngzhong He,et al.Staged singletract minimally invasive Percutaneous nephrostolithotomy and flexible ureteroscopy in the treatment of staghorn stone in patients with solitary kidney[J].Urological Research,2012,40(6):745-749.
[11]Friedlander JI,Duty BD,Smith AD,et al.Percutaneous nephrostolithotomy:an assessment of costs for prone and Galdakao-modified supine Valdivia postioning[J].Urology,2012,80(4):771-775.
[12]Mcaleer IM,Kaplan GW,Bradley JS,et al.Endotoxin content in renal calculi[J].J Urol,2003,169(5):1813-1814.
[13]Stamey T.Pathogenesis and treatment of urinary tract infections[M].Baltimore:Williams&Wilkins Co,1980:430-431.
[14]Levy MM,Artiagas A,Phillips GS,et al.Qutcomes of the surviving sepsis campaign in intensive care units in the USA and Europe:a prospective cohort study[J].LANCETInfectious Diseases,2012,12(12):919-924.
[15]郑府,杨嗣星,宋超,等.输尿管软镜碎石术中肾盂内压力监测[J].国际泌尿外科杂志,2014,34(3):339-343.