Application value of high-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL for upper urinary tract calculi
-
摘要: 目的:探讨大功率钬激光联合负压清石鞘在微通道经皮肾镜取石术(mPCNL)治疗上尿路结石中的有效性和安全性。方法:应用大功率(60~80 W:1.5~2.0 J×40 Hz)钬激光联合负压清石鞘经F20经皮肾通道治疗肾结石及输尿管上段结石共311例,其中输尿管上段结石97例,肾盂结石23例,肾盂肾盏多发结石139例,鹿角形结石52例,其中独肾患者8例,术中采用钬激光碎石后利用负压清石鞘吸出结石,记录手术时间、结石清除率以及手术并发症,并与我院既往行的普通mPCNL336例患者的相关资料进行比较。结果:311例患者术中发现脓肾患者2例,予以肾造瘘后二期手术治疗,所有患者术中、术后均未出现脓毒症,1例患者术后发生急性肾损伤及术后延迟性出血予以介入止血并输血治疗,2例患者发生气胸,1例予以胸腔闭式引流,1例予以保守治疗,平均手术时间为(76.67±50.22) min,结石清除率为88.1%,既往mPCNL的平均手术时间为(119.00±26.06) min,结石清除率为61.01%,两组患者的手术时间和结石清石率对比有显著性差异。结论:应用大功率钬激光联合负压清石鞘在mPCNL治疗上尿路结石可以明显缩短手术时间、提高结石清除率,值得临床应用及推广。
-
关键词:
- 大功率钬激光 /
- 清石鞘 /
- 微通道经皮肾镜碎石术 /
- 上尿路结石
Abstract: Objective: To investigate the efficacy and safety of high-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL for upper urinary tract calculi.Methods: Three hundred and eleven cases of renal calculi and upper ureteral calculi were treated by high-power(60-80 W: 1.5-2.0 J × 40 Hz) holmium laser combined with negative pressure lithotripsy through F20 mPNL, including 97 cases of upper ureteral calculi, 23 cases of renal pelvis calculi and 139 cases of multiple calculi of renal pelvis and calices. There were 52 cases of staghorn calculi, and 8 of which were single kidney patients. The operation time, stone clearance rate and complications were recorded.Results: Two patients with pyonephrosis were found in the high-power holmium laser combined with negative pressure lithotripsy sheath group, then they underwent two-stage operation after nephrostomy. All patients did not have sepsis during and after operation. One patient suffered from acute renal injury and delayed bleeding after operation and received interventional hemostasis and blood transfusion. Two patients developed pneumothorax. One patient received closed drainage of chest, and the other received conservative treatment. The average operation time was(76.67 ± 50.22) min, and the stone clearance rate was 88.10%. The average operation time of the conventional mini-PCNL was(119.00 ± 26.06) min, and the stone clearance rate was 61.01%. There was significant difference in the operation time and stone clearance rate between the two groups.Conclusion: High-power holmium laser and negative pressure lithotripsy sheath in mini-PCNL in the treatment of upper urinary tract calculi can significantly shorten the operation time and improve the stone clearance rate, so it's worthy of clinical application and promotion.-
Key words:
- high-power holmium laser /
- lithotripsy sheath /
- mini-PCNL /
- upper urinary calculi
-
[1] 李炯明,刘建和,陈戬,等.微通道经皮肾镜取石术治疗上尿路结石的疗效及安全性评价(附4533例报告)[J].临床泌尿外科杂志,2011,26(3):174-176.
[2] 孙颖浩,高小峰,王林辉,等.大功率钬激光经皮肾镜取石术治疗肾结石[J].中华外科杂志,2005,43(18):1209-1211.
[3] 温晓飞,陆佳荪,温机灵,等.微造瘘经皮肾镜大功率钬激光治疗肾结石128例报告[J/OL].中华腔镜泌尿外科杂志(电子版),2008,2(2):146-150.
[4] 张胜威,赵兴华,刘昌伟,等.大功率钬激光联合超微通道经皮肾镜治疗>2 cm肾结石疗效分析[J].临床泌尿外科杂志,2019,34(2):144-146.
[5] Mekayten M,Lorber A,Katafigiotis I,et al.Will Stone Density Stop Being a Key Factor in Endourology?The Impact of Stone Density on Laser Time Using Lumenis Laser p120 W and Standard 20 W Laser:A Comparative Study[J].J Endourol,2019,33(7):585-589.
[6] Sun YH,Gao XF,Zhou T, et al.70 W holmium:yttrium-aluminum-garnet laser in percutaneous nephrolithotomy for staghorn calculi[J].J Endourol,2009,23(10):1687-1691.
[7] Aldoukhi AH,Ghani KR,Hall TL,et al.Thermal Response to High-Power Holmium Laser Lithotripsy.[J].Journal of endourology,2017,31(12):1308-1312.
[8] Chen S,Zhu L,Yang S,et al.High-vs Low-power Holmium Laser Lithotripsy:A Prospective,Randomized Study in Patients Undergoing Multitract Minipercutaneous Nephrolithotomy[J].Urology,2012,79(2):297.
[9] 赖德辉,盛明,李名钊,等.负压清石鞘在经皮肾镜治疗结石梗阻性脓肾中的应用[J/OL].中华腔镜泌尿外科杂志(电子版),2019,13(1):15-19.
[10] 梁健,李逊,徐桂彬,等.经皮肾镜碎石取石术联合负压吸引治疗肾结石的Meta分析[J/OL].中华腔镜泌尿外科杂志(电子版),2019,13(6):400-404.
[11] Song L,Chen Z,Liu T,et al.The application of a patented system to minimally invasive percutaneous nephrolithotomy[J].J Endourol,2011,25(8):1281-1286.
[12] El-Nahas AR,Elshal AM,El-Tabey NA,et al.Percutaneous nephrolithotomy for staghorn stones:a randomised trial comparing high-power holmium laser versus ultrasonic lithotripsy[J].BJU Int,2016,118(2):307-312.
计量
- 文章访问数: 479
- PDF下载数: 316
- 施引文献: 0