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目的总结肾下盏入路单通道微创经皮肾穿刺取石术(MPCNL)联合输尿管镜下取石术(URL)治疗肾结石的经验。方法建立经皮肾下盏通道后行URL,在完成肾盂内碎石解除肾盂出口处梗阻后输尿管内放置双J管,然后改行单通道MPCNL。结果18例均一次肾造瘘成功。仅1例行URL时因输尿管镜未能触及结石失败,单行PCNL。手术平均时间107min。1次取石13例,2次取石5例。18例中4例有残留结石后均行体外冲击波碎石(ESWL),仅1例随访6个月仍有少量残留结石。术中、术后无严重并发症。结论肾下盏入路单通道MPCNL联合URL治疗肾结石具有效率高、结石取净率高、肾损伤小、并发症少等优点,可作为治疗以肾下盏及肾盂为主肾结石首选方法。
Objective To summarize the experience of using single channel minimally invasive percutaneous nephrolithotomy (MPCNL) combined with ureteroscopic lithotripsy (URL) in the treatment of kidney stones. Methods The percutaneous renal lower extremity channel was established and URLs were placed. Double renal tube was placed in the ureter after obstruction of the renal pelvis at the exit of renal pelvic gravel, and then the single channel MPCNL was switched to. Results 18 cases of nephrostomy were successful. Only a routine URL failed because ureteroscopy failed to reach the stone, a single PCNL. The average operation time was 107min. 1 stone in 13 cases, 2 stone in 5 cases. Of the 18 patients, 4 had ESWL after residual stones, and only 1 remained with a small amount of remaining stones at 6 months of follow-up. Intraoperative and postoperative no serious complications. Conclusions The treatment of nephrolithiasis with single channel MPCNL combined with URL of lower corneal bullae has the advantages of high efficiency, high stone removal rate, small renal injury and few complications. It can be used as the first choice for the treatment of lower kidney calyx and renal pelvis.