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目的:探讨侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石的可行性及临床应用价值。方法:回顾性分析2009年8月至2011年9月我院采用侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石患者52例的临床资料:患者同时存在肾脏铸型结石或多发结石和或输尿管上段结石,单个结石最大径8~30 mm。结果:平均手术时间60分钟(50-120分钟);术前血红蛋白116±30 g/L,术后第一天复查105±26 g/L,无大出血需要输血病例;一次结石取净率为86.5%(45/52),总取净率为92.3%(48/52)。结论:侧卧体位下经皮肾穿刺取石术及经尿道输尿管镜取石术两种术式联合应用具有可行性及互补性,在预防及减少术中出血、获得清晰的手术视野、减少灌注液外渗、增加结石清除速度及碎石成功率、缩短手术时间、减少术后发热等方面疗效显著,为治疗复杂上尿路结石提供了一个可行的新方法。
Objective: To investigate the feasibility and clinical value of percutaneous nephrolithotomy combined with transurethral ureteroscopic lithotripsy in the treatment of complicated upper urinary tract calculi. Methods: The clinical data of 52 patients with complicated upper urinary tract stones treated with percutaneous nephrolithotomy and lateral ureteroscopic lithotripsy in our hospital from August 2009 to September 2011 were retrospectively analyzed. The patients were also present Kidney mold stones or multiple stones and or upper ureteral stones, a single stone maximum diameter of 8 ~ 30 mm. Results: The average operation time was 60 minutes (50-120 minutes). The preoperative hemoglobin was 116 ± 30 g / L, and the first day after the operation was 105 ± 26 g / L. No bleeding was needed. % (45/52), the total net acquisition rate was 92.3% (48/52). Conclusion: Percutaneous nephrolithotomy and transurethral ureteroscopic lithotripsy are feasible and complementary, which can prevent and reduce intraoperative bleeding, obtain a clear operative field and reduce the perfusion fluid Seepage, increase the stone removal rate and the success rate of lithotripsy, shorten the operation time, reduce postoperative fever and other aspects of significant effect, for the treatment of complex upper urinary tract stones provides a feasible new method.