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目的研究经皮肾镜取石术联合逆行输尿管软镜治疗复杂性肾结石的安全性及有效性。方法随机选取长葛市人民医院2013年5月至2014年5月行经皮肾镜取石术(PCNL)联合输尿管软镜治疗的复杂肾结石患者40例,诊断均符合复杂性肾结石标准,无手术禁忌证。40例患者中,男22例,女18例,年龄22~65岁,平均45岁。左侧肾结石16例,右侧肾结石19例,双肾结石5例,结石直径2.1~4.3 cm。合并高血压病2例,糖尿病3例,泌尿系感染10例。高血压患者口服降压药治疗,血压控制在100~150/60~90 mm Hg(1 mm Hg=0.133 k Pa),糖尿病患者口服药物或皮下注射胰岛素将血糖控制在8.0 mmol/L以下。泌尿系感染术前输注抗生素约1周,感染控制后再手术。所有患者采取气管插管全身麻醉,先建立经皮肾镜取石通道。置入肾镜,用气压弹道碎石杆或钬激光击碎结石,用取石钳取出较大结石,小结石可通过冲洗氯化钠注射液冲出。取出所有结石后,C臂X线机透视检查残留结石,如发现有小结石残留,采用逆行输尿管软镜取石。术毕留置双J管及肾造瘘管,术后第3天复查腹部平片。术后1个月复查KUB并拔除双J管。结果本组40例患者均成功建立经皮肾工作通道碎石取石,经皮肾镜取石术联合输尿管软镜碎石取石术后上盏结石残留6例,中盏结石残留8例,下盏结石残留4例,多发结石残留9例。本组无患者出现大出血、气胸、肠道损伤、等严重并发症。手术时间(119±21)min;术后第3天结石清除率为70%(28/40),术后1个月结石清除率为87.5%(35/40)。结论经皮肾镜取石术联合逆行输尿管软镜治疗复杂性肾结石安全、有效,值得临床推广。
Objective To study the safety and efficacy of percutaneous nephrolithotomy combined with retrograde ureteroscopy in the treatment of complex renal calculus. Methods Forty patients with complex nephrolithiasis who underwent percutaneous nephrolithotomy (PCNL) combined with ureteroscopy were selected randomly from Changge People ’s Hospital from May 2013 to May 2014. All the patients were diagnosed with complicated nephrolithiasis without operation Contraindications. Forty patients, 22 males and 18 females, aged 22 to 65 years, mean 45 years. Left kidney stone in 16 cases, 19 cases of right kidney stone, kidney stones in 5 cases, stones diameter 2.1 ~ 4.3 cm. 2 cases of hypertension, 3 cases of diabetes, urinary tract infection in 10 cases. Hypertensive patients were treated with oral antihypertensive drugs. The blood pressure was controlled at 100-150/60 to 90 mm Hg (1 mm Hg = 0.133 kPa). Oral diabetes medication or subcutaneous insulin administration controlled blood glucose below 8.0 mmol / L. Urinary tract infection preoperative infusion of antibiotics for about 1 week, infection control and then surgery. All patients to take tracheal intubation general anesthesia, the first to establish percutaneous nephrolithotomy channel. Into the nephrolithotomy, lithotripsy with pneumatic lithotripsy or holmium laser crushed stones, stone loaders to remove larger stones, small stones can be washed out by flushing sodium chloride injection. Remove all stones, C-arm X-ray fluoroscopy residual stones, if found to have small stones, retrograde ureteroscopic use of stone. The surgery was left double J tube and renal fistula, the first 3 days after surgery to review the abdominal plain film. Review KUB 1 month after surgery and remove double J tube. Results The group of 40 patients were successfully established percutaneous renal access lithotripsy, percutaneous nephrolithotomy combined with ureteroscopic lithotripsy residual calculus after upper calculus in 6 cases, residual calculus in 8 cases, lower calyx stones Residue in 4 cases, multiple residual stones in 9 cases. No bleeding in this group of patients, pneumothorax, intestinal injury, and other serious complications. The operation time was 119 ± 21 min. The stone clearance rate was 70% (28/40) on the third day after operation. The stone clearance rate was 87.5% (35/40) at the first month after operation. Conclusion Percutaneous nephrolithotomy combined with retrograde ureteroscopy in the treatment of complicated renal calculi is safe and effective and is worthy of clinical promotion.