CAJ | 학술논문

目的：探讨标准通道经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石的可行性与临床疗效。方法回顾分析我院2011年1月~2013年12月收治46例复杂性肾结石患者的临床资料：完全性铸型结石、鹿角形结石27例，不完全性、多发结石19例，结石直径2.6~4.5cm。34例有肾集合系统分离，分离程度1.5~6.5cm。5例曾行肾、输尿管开放手术取石术，术后结石复发。采用标准通道经皮肾镜联合输尿管软镜同期、分期碎石取石进行治疗。结果本组46例患者均成功建立标准通道并一期碎石取石。同期手术33例，分期手术13例，其中术中因出血，患者年龄较大，结石较大、较硬，肾镜下碎石时间较长，输尿管狭窄等原因，术中决定更改分期手术7例。本组结石清除率91.3%（42/46），均未出现大出血、邻近脏器损伤、术后严重感染等并发症。结论标准通道经皮肾镜联合输尿管软镜同期、分期治疗复杂性肾结石，临床效果较好、手术创伤较小、术后恢复好，是一种安全、有效的方法。
목적：탐토표준통도경피신경연합수뇨관연경동기、분기치료복잡성신결석적가행성여림상료효。방법회고분석아원2011년1월~2013년12월수치46례복잡성신결석환자적림상자료：완전성주형결석、록각형결석27례，불완전성、다발결석19례，결석직경2.6~4.5cm。34례유신집합계통분리，분리정도1.5~6.5cm。5례증행신、수뇨관개방수술취석술，술후결석복발。채용표준통도경피신경연합수뇨관연경동기、분기쇄석취석진행치료。결과본조46례환자균성공건립표준통도병일기쇄석취석。동기수술33례，분기수술13례，기중술중인출혈，환자년령교대，결석교대、교경，신경하쇄석시간교장，수뇨관협착등원인，술중결정경개분기수술7례。본조결석청제솔91.3%（42/46），균미출현대출혈、린근장기손상、술후엄중감염등병발증。결론표준통도경피신경연합수뇨관연경동기、분기치료복잡성신결석，림상효과교호、수술창상교소、술후회복호，시일충안전、유효적방법。
Objective To explore the feasibility and clinical efficacy of kidney stones patients treated with standard channel percutaneous nephroscope jointed flexible ureteroscope at the same period operation and staging operation. Methods Retrospectively analyzed the clinical data of 46 patients with complicated kidney stone from Jan 2011 to Dec 2013. 27 cases had complete cast or staghorn calculi stones, 19 cases had incomplete or multiple stones,the diameter of stone was 2.6~4.5cm. 34 cases had renal collecting system separation,the separation degree was 1.5~6.5cm. 5 cases had ever had renal and ureter stone extraction for open surgery, postoperative recurrence of stones. With a standard channel percutaneous nephroscope jointed flexi-ble ureteroscope at the same period operation and staging operation , installment of gravel lithotomy for treatment. Results 46 patients of this group were successfully established standard channel and issue of rubble stone. 13 cases took staging operation and 33 cases took the same period operation during this period, 7 cases changed to take staging operation because of intraopera-tive bleeding, age, the size and hardness of the stone, the long time of nephroscope lithotripsy, ureteral stricture. The stone clearance rate was 91.3% (42/46), no bleeding, no adjacent viscera injury,no postoperative serious infection occured. Con-clusion Complicated kidney stone treated with standard channel percutaneous nephroscope jointed flexible ureteroscope at the same period operation and staging operation had better curative effect, less surgical trauma,better postoperative recovery. It is a safe and effective method.