CAJ | 학술논문

目的探讨经皮肾镜取石术治疗肾切开取石术后复发或残留肾结石的疗效及安全性。方法回顾性分析2008年9月至2010年1月肾切开取石术后复发或残留肾结石患者48例，均行经皮肾镜取石术治疗，其中气压弹道碎石21例，气压弹道联合超声碎石23例，双导管碎石4例。结果48例均一期手术成功，单通道取石39例，双通道取石8例，三通道取石1例。平均手术时间74 min，平均术中出血量138.6 mL，平均住院时间10 d，一次结石清除率89.58%（43/48），3例行二次取石清除残余结石，2例行体外冲击波碎石治疗。1例严重出血行超选择性肾动脉栓塞术治疗好转。无其他严重并发症。随访3～15个月无复发。结论经皮肾镜取石术治疗肾切开取石术后复发或残留结石具有创伤小、术后恢复快、安全性高等优点，可作为首选治疗方法。
목적탐토경피신경취석술치료신절개취석술후복발혹잔류신결석적료효급안전성。방법회고성분석2008년9월지2010년1월신절개취석술후복발혹잔류신결석환자48례，균행경피신경취석술치료，기중기압탄도쇄석21례，기압탄도연합초성쇄석23례，쌍도관쇄석4례。결과48례균일기수술성공，단통도취석39례，쌍통도취석8례，삼통도취석1례。평균수술시간74 min，평균술중출혈량138.6 mL，평균주원시간10 d，일차결석청제솔89.58%（43/48），3례행이차취석청제잔여결석，2례행체외충격파쇄석치료。1례엄중출혈행초선택성신동맥전새술치료호전。무기타엄중병발증。수방3～15개월무복발。결론경피신경취석술치료신절개취석술후복발혹잔류결석구유창상소、술후회복쾌、안전성고등우점，가작위수선치료방법。
Objective To explore the efifcacy and safety of the recurrent or residual renal calculus with a history of open nephrolithotomy treated with percutaneous nephrolithotomy. Methods The data of 48 cases with recurrent or residual renal calculus with a history of open nephrolithotomy from September 2008 to January 2010 were analyzed retrospectively. All patients were treated with percutaneous nephrolithotomy. 21 cases were treated with pneumatic lithotripsy, 23 cases with combined pneumatic and ultrasound lithotripsy and 4 cases with dual probe ultrasonic lithotripsy. Results All the cases were cured successfully in one stage. 39 renal units were cured by one tunnel way, 8 renal units by double tunnel and 1 renal unit by multiple tunnel. The average time for whole surgery was 74 min. The average bleeding volume was 138.6 mL. The average hospital stay was 10 days. The calculi clearance rate was 89.58%(43/48) while 3 cases with residual calculus underwent second neohroscopy and 1 case was cued by ESWL. 1 case with severe hemorrhage was cured by superselective renal artery embolization. No other complication occurred and no recurrence was found in 3 to 15 months’ follow-up. Conclusion Percutaneous nephrolithotomy is an effective and feasible therapeutic option for patients with recurrent or residual renal calculus after open operation for its advantages of less invasiveness and complications, shorter duration for hospitalization and high safety.