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目的探讨微创经皮肾镜下钬激光碎石术治疗上尿路结石的方法及疗效。方法 2007年9月2010年10月在B型超声引导下应用微创经皮肾镜下钬激光碎石术治疗上尿路结石138例,其中肾鹿角形结石64例,单发肾盂、肾盏结石38例,双肾结石8例,输尿管上段结石28例,孤立肾结石2例。结果 136例取石成功,其中95例一期取石成功(包括双通道取石5例),41例二期取石,2例因经皮肾穿失败改行开放手术取石。27例术后体外震波碎石治疗。平均结石清除率78.9%(109/138)。平均手术时间112 min,平均住院时间10 d,肾造瘘管平均留置时间4 d,双J管平均留置时间4周。5例因术中出血较多需输血。11例术后1周内出血较多,其中3例需要输血。12例出现尿外渗。7例术后出现高热(>39℃)。随访:98例伴有肾积水,时间3~6个月,平均4个月,24例积水消失,68例积水减轻,6例无改善也无加重;22例残余结石随访4~9个月,平均6个月,6例结石增大,16例结石无变化;87例随访12个月无残余结石,7例结石复发。结论微创经皮肾镜下钬激光碎石术治疗上尿路结石创伤小,恢复快,并发症少,疗效满意。
Objective To investigate the method and effect of minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy in the treatment of upper urinary tract calculi. Methods September 2007 October 2010 under the guidance of B-mode ultrasound minimally invasive percutaneous nephrolithotomy holmium laser lithotripsy 138 cases of upper urinary tract calculi, of which 64 cases of renal antler calculi, single renal pelvis, calyx 38 cases of stone, kidney stones in 8 cases, upper ureteral stones in 28 cases, isolated kidney stones in 2 cases. Results Of the 136 cases, the stones were successfully obtained, of which 95 cases were successful in the first stage (including 5 cases of double-channel stone removal), 41 cases of second-stage stone removal and 2 cases of open-operation stone removal due to percutaneous renal failure. 27 cases of postoperative extracorporeal shock wave lithotripsy. The average stone clearance rate was 78.9% (109/138). The average operation time was 112 min, the average length of hospital stay was 10 days, the average length of nephrostomy was 4 days and the average length of double J tube was 4 weeks. 5 cases due to intraoperative bleeding more blood transfusion. Hemorrhage occurred in 11 cases within 1 week after operation, of which 3 required blood transfusion. 12 cases of urine extravasation. Seven patients experienced hyperthermia (> 39 ° C). Follow-up: 98 patients with hydronephrosis, time 3 to 6 months, an average of 4 months, 24 cases of hydronephrosis disappeared, 68 cases of hydrocephalus, 6 cases without improvement without aggravating; 22 cases of residual stones were followed up 4 to 9 Months, an average of 6 months, 6 cases of stone increased, 16 cases of stone no change; 87 cases were followed up for 12 months without residual stones, 7 cases of stone recurrence. Conclusion Minimally invasive percutaneous nephrolithotomy with holmium laser lithotripsy is superior in the treatment of upper urinary tract stones with less trauma, faster recovery, fewer complications and satisfactory results.