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目的总结标准经皮肾镜联合膀胱软镜铥激光治疗复杂肾结石的疗效、安全性,探讨其临床应用价值。方法回顾性分析2011年9月至2015年5月,接受标准经皮肾镜联合膀胱软镜铥激光碎石治疗复杂肾结石患者91例的临床资料,采用超声引导下建立F22标准经皮肾镜通道后,使用第四代EMS超声/气压弹道碎石系统清除视野内结石。术后更换电子膀胱软镜,检查各盏内结石残留情况,铥激光碎石并将残渣冲出。术后复查泌尿系平片评估碎石效果。术后3 d复查KUB,以结石>4 mm为有临床意义残留。术后第2个月复查肾功能,随访8~24个月结果 91例患者均碎石成功,无术中、术后严重并发症发生。手术时间40~110 min,平均55.3 min。术后留置肾造瘘管4~5d,双J管保留4~8周。复查泌尿系平片,结石完全清除率89.0%(81/91),总清石率94.5%(残石≤4 mm,不需特殊处理5例),5例患者结石残留0.5~0.9 cm,给予体外冲击波碎石结合排石药物口服治疗,均未能完全排石。随访8~24个月,平均15.60个月,无肾功能受损患者。结论标准经皮肾镜联合膀胱软镜铥激光治疗复杂肾结石具有清石率高、微创、安全的优势,疗效确切、持久的优点。
Objective To summarize the curative effect and safety of standard percutaneous nephrolithotomy combined with bladder soft-ware 铥 laser in the treatment of complex nephrolithiasis and to explore its clinical value. Methods The clinical data of 91 patients with complicated renal calculus undergoing standard percutaneous nephrolithotomy combined with bladder soft-tip laser lithotripsy from September 2011 to May 2015 were retrospectively analyzed. F22 standard percutaneous nephrolithotomy Channel, the use of the fourth generation of EMS ultrasound / pneumatic lithotripsy system to clear the visual field of stones. After the replacement of electronic bladder soft mirror, check the light of the residual stones, 铥 laser gravel and the residue out. Postoperative urinary plain film review gravel effect. 3 days after the review KUB, with stones> 4 mm for the clinical significance of the residue. Renal function was reviewed at the second month after operation. All the patients were followed up for 8-24 months. All the 91 patients were successful with gravel. No intraoperative or postoperative serious complications occurred. Surgery time 40 ~ 110 min, an average of 55.3 min. Postoperative indwelling renal fistula 4 ~ 5d, double J tube for 4 to 8 weeks. Urine plain film was reviewed. The complete stone removal rate was 89.0% (81/91), the total clear stone rate was 94.5% (residual stone≤4 mm, no special treatment was required), and 5 patients had residual stones of 0.5 to 0.9 cm. Extracorporeal shock wave lithotripsy combined with row of stone drugs oral treatment, were unable to completely row the stone. Follow-up 8 to 24 months, an average of 15.60 months, no renal impairment in patients. Conclusion The standard percutaneous nephrolithotomy combined with bladder soft-tip laser treatment of complex renal calculi has the advantages of high rate of clear stone, minimally invasive and safe advantages, exact curative effect and long lasting effect.