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目的探讨经皮肾镜取石术(PCNL)钬激光联合超声碎石治疗鹿角形肾结石的可行性和疗效。方法 2010年4月至2011年5月,我院共对36例鹿角形肾结石实施了PCNL钬激光联合超声碎石治疗。首先建立22F的手术通道,钬激光快速将结石击碎为10mm内碎石,再通过超声碎石将结石清除,对于需要建立的的其他通道均采用18F或16F的微通道。结果手术均取得成功,单通道取石29例,双通道取石7例,平均手术时间105min。一次手术取净结石26例(72.2%),二次手术联合体外冲击波碎石取石术(ESWL)治疗7例。术后随访1～3个月,总无石率91.7%,无严重并发症发生。结论 PCNL联合钬激光和超声碎石治疗鹿角形肾结石具有清石效率高、手术时间短、无石率高、并发症少等优点。
Objective To investigate the feasibility and efficacy of percutaneous nephrolithotomy (PCNL) holmium laser combined with ultrasonic lithotripsy in the treatment of antler kidney stones. Methods From April 2010 to May 2011, 36 cases of antler kidney stones were treated with PCNL holmium laser combined with ultrasonic lithotripsy. First of all, a 22F surgical access was established. The holmium laser rapidly crushed the stones into 10mm internal gravel, and the stones were cleared by ultrasonic lithotripsy. Other channels that need to be established are 18F or 16F microchannels. Results All the surgeries were successful. Among them, 29 cases were single-channel stone and 7 cases were double-channel stone. The average operation time was 105 minutes. Twenty-six cases (72.2%) were treated with net stones in one operation, and seven cases were treated by second surgery combined with extracorporeal shock wave lithotripsy (ESWL). Follow-up 1 to 3 months after surgery, the total stone-free rate of 91.7%, no serious complications. Conclusion PCNL combined holmium laser and ultrasonic lithotripsy for the treatment of deer antagonal nephrolithiasis has many advantages such as high efficiency of stone cleaning, short operation time, high stoneless rate and few complications.