结合内镜检查的肾内手术治疗复杂性肾结石32例报告

高小峰; 彭泳涵; 李凌; 周铁; 王林辉; 孙颖浩

结合内镜检查的肾内手术治疗复杂性肾结石32例报告

- 第二军医大学长海医院泌尿外科(上海, 200433)

详细信息

通讯作者: 孙颖浩,E-mail:sunyh@medmail.com.cn

中图分类号: R692.4

收稿日期: 2013-06-02

Endoscopic combined intra-renal surgery for complex renal stones: report of 32 cases

- Department of Urology, Changhai Hospital, The Second Military Medical University, Shanghai, 200433, China

More Information

Corresponding author: SUN Yinghao, E-mail: sunyh@medmail.com.cn

Received Date: 02 June 2013

摘要

摘要: 目的：探讨结合内镜检查的肾内手术（endoscopic combined intra-renal surgery， ECIRS）在治疗复杂性肾结石中的安全性及有效性。方法：自2009年9月~2012年4月期间，32例复杂性肾结石患者接受了ECIRS。在改良的斜侧卧位下，所有患者均接受顺行经皮肾镜和逆行输尿管软镜的联合治疗。术前均行静脉肾盂造影及腹部CT平扫判断结石的位置和负荷。术后行CT平扫检查评估结石排净率，残留结石<2 mm视为碎石成功。结果：患者平均结石最大直径4.8 cm。多发肾结石分布于分支型肾盂肾盏内者7例；多发性肾结石累及多个平行后组肾盏者25例。最初3例患者为经皮肾镜取石术后，存在成熟的经皮肾通道。其余29例患者均同期建立顺行及逆行通道：25例患者成功Ⅰ期碎石；4例患者因肾盂黏膜轻度渗血导致视野不清改行Ⅱ期手术。平均手术时间为75（56~170） min。术中、术后均无严重并发症发生。患者碎石成功率为100%，结石完全清除率为93.8%（30/32），2例患者残留结石<2 mm。结论：ECIRS提高了单通道经皮肾镜手术结石清除率，并降低了因增加经皮肾通道带来的潜在风险。
- 输尿管镜 /
- 经皮肾镜取石术 /
- 肾结石
Abstract: Objective: To determine the safety and efficiency of endoscopic combined intra-renal surgery (ECIRS) in the treatment of complex renal stones.Method: From September 2009 to April 2012, 32 cases of complex renal stones were treated with ECIRS. All procedures were performed anterograde and retrograde access simultaneously in the Galdakao-modified supine Valdivia position. The preoperative investigation protocol included assessment of the stone burden and location by intravenous pyelography and non-contrast abdominal computed tomography. Non-contrast CT scan was used to evaluate the result of surgery. Success was defined as stone-free status or residual fragments less than two millimeters.Result: The mean maximal diameter was 4.8 cm. Multiple branched renal pelvis stones were seen in seven cases. Renal stones involving multiple parallel posterior calyces were seen in 25 patients. The first three patients was conducted PCNL with the established renal tract. The other 29 cases established the anterograde and retrograde access simultaneously. The outcome of the surgery was successful in 25 patients. Two-stage operation were performed for 4 patients due to poor visualization caused by the minor renal bleeding. Mean operative time was 75 (56-170) min. No severe intraoperative and postoperative complications occurred. Stone fragment success rate was 100%. Stone clearance was achieved in 30 patients (93.8%). Two patients had small residual stones (<2 mm).Conclusion: ECIRS can effectively increase the stone clearance rate in the single tract PCNL and reduce the number of percutaneous access tracts and tract-associated risk.
- ureteroscopy /
- percutaneous nephrolithotripsy /
- nephrolithiasis

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