可视标准通道联合F4.8 可视穿刺超微经皮肾镜在肾多发结石中的应用（附46 例报告）

Combined standard percutaneous nephrolithotomy and 4.8Fr micro- percutaneous nephrolithotomy and for multiple renal calculi (46 cases)

摘要:

目的 探讨可视标准通道联合F4.8 可视穿刺超微经皮肾镜治疗肾多发结石中的应用。方法 回 顾性分析2015 年10 月-2016 年9 月该院46 例肾多发结石患者的临床资料，男28 例，女18 例，年龄25 ～ 65 岁， 平均42.6 岁。结石直径3.0 ～ 5.2 cm，平均（4.3±0.8）cm。应用F4.8 可视穿刺辅助球囊扩张建立标准通道， 肾镜联合超声碎石处理视野内可见结石后，再应用F4.8 可视穿刺超微经皮肾镜联合钬激光处理其他部位结石， 总结通道建立总时间、手术时间、血红蛋白下降值、一期结石清除率及手术并发症等指标。结果 所有病例 在F4.8 可视穿刺辅助下成功建立单标准通道，其中24 例联合单超微通道，16 例联合双超微通道，6 例联合3 个超微通道。术后均留置单个肾造瘘管，超微通道未留置造瘘管，术后均留置F5 双J 管。F4.8 可视穿刺建立 标准通道建立时间（6.8±1.8）min、单个F4.8 可视穿刺超微通道建立时间（4.5±0.9）min、手术时间（92.0± 15.0）min。一期结石清除率91.3%（42/46）、血红蛋白下降值（12.2±2.5）g/L，术后发热8 例，给予抗炎治 疗好转，4 例肾下盏可见0.5 ～ 0.8 cm 结石残留，给予体外冲击波碎石，联合应用体位排石，术后1 个月复查 结石均排出，未出现石街、迟发出血、周围脏器损伤、输尿管损伤病例。结论 可视标准通道联合F4.8 可视 穿刺超微经皮肾镜治疗肾多发结石具有减少大通道数量、清石率高、安全可靠和并发症少等优点，应用F4.8 可视穿刺通道的建立更加安全精准。

Abstract:

Objective To explore the application of visible standard channel combined with F4.8 visible puncture percutaneous nephrolithotomy in the treatment of multiple renal calculi. Methods The clinical data of 46 patients with multiple renal calculi from October 2015 to September 2016 were retrospectively analyzed. There were 28 male and 18 female, with a mean age of 42.6 years (aged from 25 to 65 years). Stone diameter 3.0~5.2 cm, average (4.3 ± 0.8) cm. Application of F4.8 visual puncture assisted angioplasty to establish the standard channel, nephrolithotomy combined with ultrasonic lithotripsy treatment in the field of visible stones, then apply the F4.8 visual micro puncture percutaneous nephrolithotomy combined with holmium laser treatment of other parts of the stone, summarizes the channel establishment total time, operation time, blood red protein decreased and stone clearance rate and complication index. Results All cases were successfully established single standard channel under the guidance of F4.8 visual puncture, 24 cases were combined with single ultramicro channel, 16 cases were combined with double ultramicro channels, and the other 6 cases were combined with the three ultra microchannels. Postoperative indwelling single renal fistula, micro channel indwelling fistula, postoperative indwelling F5 double J tube. F4.8 visual puncture established standard channel establishment time (6.8 ± 1.8) min, single F4.8 visible puncture ultra - channel establishment time of (4.5 ± 0.9) min, operation time of (92.0 ± 15.0) min. A stone clearance rate was 91.3% (42/46), a decrease in hemoglobin value of (12.2 ± 2.5) g/L, 8 cases of postoperative fever, given anti-inflammatory treatment improved, 4 cases with residual calyceal stones visible 0.5~0.8 cm, given extracorporeal shock wave lithotripsy combined with postural drainage, stone, 1 months after the treatment of stones were discharged, did not appear Shi Jie, delayed bleeding, adjacent organ injury, ureteral injury cases. Conclusion Visual standard channel combined with F4.8 ultra visible puncture percutaneous nephrolithotomy in treatment of multiple renal calculi has the advantages of reducing the large number of channels, high stone clearance rate, safety, less complications, F4.8 was used to establish the visual puncture channel is more safe and accurate.