CAJ | 학술논문

目的探讨经皮肾镜联合软性膀胱镜治疗复杂性肾结石的临床应用价值.方法回顾性分析2011年7月至201 3年9月53例采用单通道经皮肾镜联合软性膀胱镜治疗的复杂性肾结石患者临床资料.男31,女22例.年龄26～74岁,平均49岁.左肾结石32例,右肾结石19例,双侧结石2例,鹿角形结石21例,多发肾结石32例,结石均分布于2个以上肾盏,合并输尿管上段结石7例,孤立肾结石2例.结石最大径2.5～ 4.6 cm,平均3.7 cm.肾积水39例,集合系统分离2.0～5.1 cm,平均3.8 cm.病程1个月～6年,其中14例曾行体外冲击波碎石治疗,6例曾行开放手术取石.53例均在彩色多普勒超声引导下经皮肾穿刺单通道取石,扩张经皮肾穿刺通道至24 F.结果 53例(55侧)均一期成功取石,手术时间85～ 170 min,平均119 min.一期结石清除率89％(49/55).术后血红蛋白下降3.9 ～ 9.2 g/L,平均6.1 g/L.住院天数8～12d,平均9.2 d.2例术后有明显出血,出血量约500 ml,夹闭肾造瘘管,对症治疗后出血自行停止,无输血病例.术后当日发热2例,术后第1天发热1例,经抗感染治疗2～3d后体温恢复正常.未发生肾穿孔、液气胸及周围脏器损伤.6例结石残留,其中2例二期手术取净结石、4例行体外冲击波碎石.结论经皮肾镜联合软性膀胱镜治疗复杂性肾结石创伤小、结石清除率高、并发症少,具有较高的临床应用价值.
목적 탐토경피신경연합연성방광경치료복잡성신결석적림상응용개치.방법 회고성분석2011년7월지201 3년9월53례채용단통도경피신경연합연성방광경치료적복잡성신결석환자림상자료.남31,녀22례.년령26～74세,평균49세.좌신결석32례,우신결석19례,쌍측결석2례,록각형결석21례,다발신결석32례,결석균분포우2개이상신잔,합병수뇨관상단결석7례,고립신결석2례.결석최대경2.5～ 4.6 cm,평균3.7 cm.신적수39례,집합계통분리2.0～5.1 cm,평균3.8 cm.병정1개월～6년,기중14례증행체외충격파쇄석치료,6례증행개방수술취석.53례균재채색다보륵초성인도하경피신천자단통도취석,확장경피신천자통도지24 F.결과 53례(55측)균일기성공취석,수술시간85～ 170 min,평균119 min.일기결석청제솔89％(49/55).술후혈홍단백하강3.9 ～ 9.2 g/L,평균6.1 g/L.주원천수8～12d,평균9.2 d.2례술후유명현출혈,출혈량약500 ml,협폐신조루관,대증치료후출혈자행정지,무수혈병례.술후당일발열2례,술후제1천발열1례,경항감염치료2～3d후체온회복정상.미발생신천공、액기흉급주위장기손상.6례결석잔류,기중2례이기수술취정결석、4례행체외충격파쇄석.결론 경피신경연합연성방광경치료복잡성신결석창상소、결석청제솔고、병발증소,구유교고적림상응용개치.
Objective To evaluate the clnical value of percutaneous nephrolithotomy combined with flexible cystoscope in the treatment of complicated renal calculi.Methods Data of 53 cases of complex renal calculi treated with single channel percutaneous nephrolithotomy combined with flexible cystoscope from July 2011 to September 2013 were analyzed retrospectively.There were 31 males and 22 females.Their age ranged from 26 to 74 years with a mean age of 49 years.Thirty-two cases were located on the left side,19 cases right,2 cases bilateral,21 cases of staghorn calculi and 32 cases of multiple stones.All the stones were filled in 2 or more calyces,with 7 cases in upper ureteral stones at the same time and 2 cases in solitary kidney.The longest diameter of stones was between 2.5 cm to 4.6 cm,with an average of 3.7 cm.There were 39 cases with hydronephrosis and the separation of the collection system was 2.0-5.1 cm with an average of 3.8cm.The period which patients suffered from stones was from 1 month to 6 years.Fourteen cases underwent ESWL and 6 cases underwent open operation before percutaneous nephrolithotomy.All patients underwent single channel percutaneous nephrolithotomy under the guidance of color Doppler ultrasound,and the channel of puncture was expanded to 24 F.Results Fifty-three cases (55 sides) were performed successfully in one-stage sugery and the operation time was between 85 to 170 min,with an average of 119 min.The stone clearance rate was 89％ (49/55) and postoperative hemoglobin decreased 3.9-9.2 g/L with an average of 6.1 g/L.The hospitalization time was 8 to 12 days with an average of 9.2 days.Two cases had hemorrhage of about 500 ml after surgery and the renal hemorrhage stopped after clamping of renal fistula without blood transfusion.Two patients suffered from fever on surgery day and 1 patient on one day after surgery,and the body temperature returned to normal level after anti-infection treatment for 2 or 3 days.No renal perforation,fluid pneumothorax or damaged surrounding organs occurred.6 patients had residual stones,among which 2 were treated by two-stage operation and 4 were treated with extracorporeal shock wave lithotripsy.Conclusion Percutaneous nephrolithotomy combined with flexible cystoscope has little trauma and high stone clearance rate in the treatment of complex renal calculi with high clinical value.