摘要
目的 评价微创经皮肾输尿管硬镜联合软镜下Nd：YAG激光碎石术治疗复杂性上尿路结石的疗效.方法 2005年12月～2006年9月,B超引导穿刺建立14～18 F通道,8.0～9.8 F输尿管硬镜联合软镜下Nd：YAG激光治疗53例复杂性上尿路结石.肾结石31例,肾结石合并输尿管结石7例,输尿管结石15例,对手术时间、结石处理时间、并发症和结石清除率进行分析.结果 53例均Ⅰ期顺利建立皮肾通道,其中47例1期单通道完成碎石,1例鹿角状结石因碎石量多而行1期双通道碎石术,5例肾结石经原通道行Ⅱ期碎石术,手术时间55～180 min,平均（100±15）min;结石处理时间25～135 min,平均（65±11）min,全部病例均无肾盂穿孔、气胸、腹腔内脏器官损伤等严重并发症发生.术后3～7 d复查腹部平片,复杂性肾结石总清除率为89.5%（34/38）,输尿管结石清除率为100%（15/15）.结论 B超引导下穿刺微创经皮肾输尿管硬镜联合软镜下Nd：YAG激光碎石术具有碎石效率高,残石率低,对肾脏和输尿管组织损伤小,可有效缩短手术时间,安全有效.
[Objective] To evaluate the clinical efficacy and safety of minimally invasive percutaneous nephrostomy Nd：YAG laser lithotripsy with rigid ureteroscope combined with flexible ureteroscope for complex upper urinary calculi. [Methods] From December 2005 to September 2006, 31 cases of complex renal calculi, 7 cases of complex renal calculi with ureteral calculi, 15 cases of complex ureteral calculi were performed by minimally invasive pereutaneous nephrostomy Nd：YAG laser lithotripsy with rigid ureteroscope combined with flexible ureteroscope under B-ultrasound guidance. Clinical data including operation time, lithotripsy time, complications and stone free rate was analyzed retrospectively. [Results] The percutaneous renal access （14-18F） was successfully established under B- ultrasound guidance in all cases. Immediate phase Ⅰ lithotripsy was performed in 47 cases through single tract and in one case through two tracts and delayed phase Ⅱ lithotripsy in 5 cases of complex renal calculi. Operation time ranged from 55 to 180 minutes, and average operation time was （100±15） minutes. Lithotripsy time ranged from 25 to 135 minutes, and average lithotripsy time was （65±11） minutes. Severe complications did not occur. Complex renal calculis were cleared in 34 out of 38 cases （89.5%）. All ureteral calculis were completely cleared in 15 cases （100%）. [Conclusion] Minimally invasive percutaneous nephrostomy Nd：YAG laser lithotripsy with rigid ureteroscope combined with flexible ureteroscope for complex upper urinary calculi has the advantages of effectiveness, mini-invasion, less operative duration and safety.
出处
《中国内镜杂志》
CSCD
北大核心
2007年第7期681-683,共3页
China Journal of Endoscopy
