论文部分内容阅读
目的总结经皮肾镜取石术(PCNL)术后结石残留的可能原因及处理方法、术后干预措施。方法回顾性分析采用经皮肾镜下钬激光碎石清石术处理复杂肾结石160例患者资料。结果42例二期PCNL取石患者,除1例二期取石结石落入输尿管中术后带双J管同时辅助ESWL治疗,3例结石进入肾脏后下盏,肾镜无法探及未作处置外,其余38例术中在B超和输尿管镜的辅助下全部成功取石。结论术后结石残留、复发原因复杂,处理困难。对于PC-NL术后结石残留、复发我们的体会是预防为主:①术前明确结石的数目、部位、大小,肾盂、肾盏形态和肾功能情况;②碎石过程中,首先解除肾盂或输尿管梗阻,放置双J管后再处理其他结石;③提高结石碎石率;④术中应用超声及X线检查可以帮助确定有无残石;⑤有针对性地选择饮食干预、药物治疗能降低PCNL术后结石复发的比率。
Objective To summarize the possible causes and management of residual stones after percutaneous nephrolithotomy (PCNL) and the intervention measures after operation. Methods The clinical data of 160 patients with complex renal calculi treated by percutaneous nephroscope, holmium laser lithotripsy and lithotripsy were retrospectively analyzed. Results In 42 patients with stage II PCNL, one case with stage II stones fell into the ureter with double J tube and assisted with ESWL. Three cases of stones entered the posterior wall of the kidney and the nephrolithotomy could not be explored and treated. The remaining 38 cases underwent surgery in the B ultrasound and ureteroscopy with the help of all successful stone. Conclusion Postoperative residual stones, recurrence of complicated reasons, difficult to handle. For PC-NL postoperative residual stones, recurrence of our experience is prevention: ① preoperative clear stone number, location, size, renal pelvis, calyx morphology and renal function; ② gravel, the first to lift the renal pelvis or Ureteral obstruction, placed double J tube and then deal with other stones; improve the rate of stone lithotripsy; intraoperative use of ultrasound and X-ray examination can help determine the presence or absence of residual stone; ⑤ targeted dietary intervention, drug treatment can be reduced The rate of stone recurrence after PCNL.