CAJ | 학술논문

目的探讨经皮肾造瘘软膀胱镜下应用钬激光治疗上尿路结石的有效性与安全性.方法经皮肾造瘘软膀胱镜下应用钬激光治疗肾和输尿管中上段结石26例.其中肾结石合并输尿管结石8例、肾多发结石5例、单纯肾盏结石4例、输尿管中上段结石9例.结石直径1.0～3.2 cm,平均2.2 cm.肾轻度积水4例,中度积水15例,重度积水7例,合并肾功能不全13例.均在B超引导下经肾中盏穿刺单通道取石.结果 22例一期取石成功,4例二期取石.18 F穿刺通道18例,24 F穿刺通道6例.手术时间45～140 min,平均72 min.结石取净率96.2%(25/26),术中和术后均无输血.术后高热1例,抗感染治疗2 d后体温正常,无其他明显并发症.术后22例平均随访(11±4)个月,B超复查患肾积水明显减轻,未见结石复发.结论经皮肾造瘘软膀胱镜下钬激光碎石是治疗上尿路结石的一种有效的微创方法,尤其适用于肾盏和输尿管中上段结石.
목적 탐토경피신조루연방광경하응용화격광치료상뇨로결석적유효성여안전성.방법경피신조루연방광경하응용화격광치료신화수뇨관중상단결석26례.기중신결석합병수뇨관결석8례、신다발결석5례、단순신잔결석4례、수뇨관중상단결석9례.결석직경1.0～3.2 cm,평균2.2 cm.신경도적수4례,중도적수15례,중도적수7례,합병신공능불전13례.균재B초인도하경신중잔천자단통도취석.결과 22례일기취석성공,4례이기취석.18 F천자통도18례,24 F천자통도6례.수술시간45～140 min,평균72 min.결석취정솔96.2%(25/26),술중화술후균무수혈.술후고열1례,항감염치료2 d후체온정상,무기타명현병발증.술후22례평균수방(11±4)개월,B초복사환신적수명현감경,미견결석복발.결론 경피신조루연방광경하화격광쇄석시치료상뇨로결석적일충유효적미창방법,우기괄용우신잔화수뇨관중상단결석.
Objective To assess the efficacy and safety of flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy in the treatment of upper urinary tract calculi.Methods The flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy was performed on 26 patients from Jul 2005 to Jan 2007. Among these patients, 8 had bilateral renal calculi and ureteral calculi, 5 had multiple renal calculi, 4 had renal calyx calculi and 9 had ureteral calculi. The average diameter of the calculus was 2.2 cm (range from 1.0-3.2 cm). Four patients had mild hydronephrosis, others had moderate or severe hydronephrosis. Insufficient renal function was noted in 13 cases. The procedure was performed via a single tract through the middle calyx under the ultrasonic guidance in all cases.Results Twenty-two cases achieved stone free at primary procedure, secondary procedure was needed in 4 cases. A 18 F tract was used in 18 cases and 24 F tract was used in the left 8 cases. The average operation time was 72 min, stone-free rate was 96.2%(25/26),and there was no blood transfusion. One patient had fever after the procedure and recovered 2 days after the administration of antibiotics. No other complication was recorded. In an average 11 month follow-up in 22 patients, hydronephrosis reduction was significant observed by ultrasound scan. No calculus relapse was found.Conclusions Flexible cystoscope conducted holmium laser lithotripsy via percutaneous nephrostomy is an effective and minimally invasive technique for the treatment of upper urinary tract calculus. It has the advantages in dealing with the calyx and ureteral calculus located in the proximal or middle segment as well.