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目的:探讨采用侧卧斜仰截石位单通道微创经皮肾镜联合输尿管软镜一期治疗复杂性肾结石的临床疗效,评估手术的安全性、高效性及可行性。方法:回顾性研究2014年7月~2017年3月,采用侧卧斜仰截石位行微创PCNL联合输尿管软镜一期治疗复杂性肾结石的患者18例,男10例,女8例,平均36.4岁,完全鹿角形结石7例,多发性肾结石11例。结果:本组18例患者均手术成功,无一例中转开放手术。全部采用F18单通道经皮肾镜联合输尿管软镜碎石。平均手术时间(75.3±40.7)min,平均住院时间(7.1±5.6)d。一次性结石清除率为83.3%(15/18),残留结石3例,其中1例二期输尿管软镜取尽结石,2例行ESWL治疗。术中及术后无严重出血及感染病例,无输血及动脉栓塞治疗病例;低热2例予敏感抗生素治疗后痊愈,无胸膜、结肠等腹腔脏器损伤等并发症发生。结论:侧卧斜仰截石位单通道微创经皮肾镜联合输尿管软镜一期治疗复杂性肾结石安全高效,穿刺通道少,碎石成功率高,平均住院时间短。
Objective: To investigate the clinical efficacy of lateral oblique oblique lithotripsy single-channel minimally invasive percutaneous nephrolithotomy combined with ureteroscopy in the treatment of complex renal calculi and to evaluate the safety, efficacy and feasibility of the operation. Methods: From July 2014 to March 2017, 18 patients (10 males and 8 females) who underwent minimally invasive PCNL combined with ureteroscopy for the treatment of complex renal calculi were retrospectively studied. , An average of 36.4 years old, complete antler stone in 7 cases, multiple renal stones in 11 cases. Results: All the 18 patients in this group were operated successfully, none of whom underwent open surgery. All using F18 single-channel percutaneous nephrolithotomy ureteroscopic soft lithotripsy. The average operation time (75.3 ± 40.7) min, the average hospital stay (7.1 ± 5.6) d. Disposable stone clearance rate was 83.3% (15/18), residual stones in 3 cases, of which 1 case of secondary ureteroscopy removed stones, 2 cases of ESWL treatment. No intraoperative and postoperative serious bleeding and infection cases, no transfusion and arterial embolization cases; low fever in 2 cases treated with sensitive antibiotics cured, no pleural, colon and other complications of abdominal organ injury occurred. Conclusion: The minimally invasive percutaneous nephrolithotomy combined with ureteroscopy in the treatment of complicated renal calculi is safe and efficient with fewer puncture passages, high success rate of gravel, and shorter average length of hospital stay.