CAJ | 학술논문

目的：探讨微肾镜联合大功率钬激光治疗复杂肾结石的疗效及安全性。方法收集复杂肾结石患者50例,采用微肾镜联合大功率钬激光治疗,观察患者的手术时间、术中出血量、一次结石取净率、尿液转清时间、术后住院时间及并发症发生情况；观察患者血肌酐、尿素氮变化情况；术后随访记录结石复发情况。结果本组50例患者,一次手术结石取净率为78.0%。转开放手术取石率为4%。接受二期碎石或取石占10%。术中无胸膜损伤及肠管损伤等严重并发症发生。手术时间(67.5±10.7)min。术后尿液转清的平均时间(41.3±2.6)h。术后住院天数(8.2±1.4)d。肾造瘘管留置时间(6.5±1.2)d,尿管留置时间(8.8±2.1)d。所有患者未行双通道或多通道取石。随访(3.8±1.4)个月。术后2h、术后24h、术后7d时患者血肌酐、尿素氮水平均较术前明显增高(﹤0.05),术后24h达峰值,随后开始下降,至术后30d时降至术前水平。结论微肾镜联合大功率钬激光治疗复杂肾结石,可有效提高碎石、取石效率,缩短患者住院时间,并发症少,对肾脏结构及功能损伤小,大多数患者血肌酐、尿素氮水平在术后7d下降,术后30d回复正常,表明该术式安全可靠。术前、术中、术后应注意相关并发症的预防及治疗,如此可有效降低并发症发生率,极大提高临床总有效率。
목적：탐토미신경연합대공솔화격광치료복잡신결석적료효급안전성。방법수집복잡신결석환자50례,채용미신경연합대공솔화격광치료,관찰환자적수술시간、술중출혈량、일차결석취정솔、뇨액전청시간、술후주원시간급병발증발생정황；관찰환자혈기항、뇨소담변화정황；술후수방기록결석복발정황。결과본조50례환자,일차수술결석취정솔위78.0%。전개방수술취석솔위4%。접수이기쇄석혹취석점10%。술중무흉막손상급장관손상등엄중병발증발생。수술시간(67.5±10.7)min。술후뇨액전청적평균시간(41.3±2.6)h。술후주원천수(8.2±1.4)d。신조루관류치시간(6.5±1.2)d,뇨관류치시간(8.8±2.1)d。소유환자미행쌍통도혹다통도취석。수방(3.8±1.4)개월。술후2h、술후24h、술후7d시환자혈기항、뇨소담수평균교술전명현증고(﹤0.05),술후24h체봉치,수후개시하강,지술후30d시강지술전수평。결론미신경연합대공솔화격광치료복잡신결석,가유효제고쇄석、취석효솔,축단환자주원시간,병발증소,대신장결구급공능손상소,대다수환자혈기항、뇨소담수평재술후7d하강,술후30d회복정상,표명해술식안전가고。술전、술중、술후응주의상관병발증적예방급치료,여차가유효강저병발증발생솔,겁대제고림상총유효솔。
Objective To explore the ef icacy and safety of treating complicated renal calculi with micro nephrostomy combined with high power holmium laser. Methods 50 patients with complex renal calculi were treated with micronephrostomy combined with high power holmium laser,the hospitalization time operation time,intraoperative bleeding volume, a stone clearance rate, time of clear urine,postoperative and complications were observed, the serum creatinine, urea nitrogen change and recur ence of hepatolithiasis were observed.Results In this group, 50 patients,the one time operation stone clearance rate was 78%,stone removal rate of conversed openoperation was 4%. The rate accepted two crushed stone or stoneaccounted was 10%. There were no serious complications of pleural injury and intestinal injuryin operation. The Operation time was (67.5 ± 10.7) minutes. The average time of postoperative urine turned clear was (41.3 ± 2.6) hours. Postoperative hospital stay was (8.2 ± 1.4) days. Nephrostomy tube indwel ing time was (6.5 ± 1.2) days, catheter indwel ing time was (8.8 ± 2.1) days. Al patients did not receive double or multiple channels and stone. Fol ow up time was (3.8 ± 1.4) months.At 2 hours, 24hours after operation,postoperative 7d patients' serum creatinine, urea nitrogen levels were significantly higher than those of preoperative ( ﹤0.05),at postoperative 24h they reached peak, and then began to decline, and at postoperative 30days they were downed to preoperative level. Conclusion Complicated renal calculi is treated with micro nephrostomy combined with high power holmium laser can ef ectively improve the gravel, stone extraction ef iciency, shorten the time of hospitalization, reduce complications and injury of renal structure and function,the majority of patients' serum creatinine, urea nitrogen levels decreased at postoperative 7days,at postoperative 30 days they returned to normal, the operation is safe and reliable. At preoperative, intraoperative, postoperativeshould should be payed at ention to related complications, so as to ef ectively reduce the incidence of complications, improve the clinical total ef ective rate.