摘要
目的探讨微创经皮肾穿刺输尿管镜下钬激光碎石、取石术治疗孤立肾结石的临床效果。方法2008年2月～2009年1月,对15例孤立肾结石均采取在C形臂X线机定位下,患肾输尿管内置入输尿管导管逆行造影显示患肾集合系统后微创经皮肾穿刺造瘘建立F16～F18皮肾通道,在输尿管镜下用钬激光一期或多期碎石、取石。结果12例一期取石成功,2例因结石大行二期取石,1例因患者高龄,结石大、散在三期取石。术中无一例肾盂穿孔及肾皮质撕脱。术后5～10d复查肾功能,血肌酐从118～569μmol/L降至68～126μmol/L。13例随访6～8个月,2例结石复发,<0.4cm,给予排石、观察治疗结石排出。结论微创经皮肾穿刺输尿管镜下钬激光碎石、取石术治疗孤立肾结石具有创伤小、安全、疗效好等优点,尤其对年龄大、不能耐受开放手术的孤立肾结石患者优势明显。
Objective To investigate the efficacy of minimally invasive surgery in the treatment of patients with renal calculi in solitary. Methods Totally 15 patients with renal calculi in solitary kidney were admitted to Meishan People’s Hospital from February 2008 to January 2009. Under the guidance by a C-arm X-ray machine, minimally invasive percutaneous nephrolithotomy with holmium laser was performed. During the procedure, retrograde urography was performed with ureteral catheter through the ureter of the diseased kidney, percutaneous nephrostomy were then carried out with F16-F18 channel, and holmium laser with ureteroscope was used in one or more sessions. Results In our cases, 12 patients were cured in one session, 2 patients received a second operation because of huge stones, and one patient underwent totally three sessions because of old age, and scattered big stones. No perforation of the renal pelvis nor avulsion of the renal cortex occurred. Postoperative examination of renal function showed that the serum creatinine decreased from 118-569 μmol/L to 68-126 μmol/L in 5-10 days after their operations. Thirteen patients achieved a follow-up for 6 to 8 months, during which two cases had recurrent renal stones （0.4 cm） and then were cured by traditional therapy. Conclusions Minimally invasive percutaneous nephrolithotomy with holmium laser is safe and effective for renal calculi in solitary kidney with advantages of less invasion and low rate of complications. It can be used as the first choice for the treatment of renal calculi, especially for the elderly patients who cannot tolerate traditional open operation.
出处
《中国微创外科杂志》
CSCD
2010年第4期302-303,共2页
Chinese Journal of Minimally Invasive Surgery
关键词
孤立肾
肾结石
微创经皮肾取石术
Solitary kidney
Calculi
Minimally invasive percutaneous nephrolithotomy
