F4.8可视穿刺针式肾镜治疗特殊类型肾结石的临床研究*

F4.8 Micro-percutaneous nephrolithotomy in treatment of special types of kidney stones*

摘要:

探讨可视穿刺针式肾镜治疗特殊类型肾结石的临床疗效及安全性。方法?2016年6月-2017年8月，采用F4.8铂立可视穿刺针式肾镜对46例特殊类型肾结石患者进行钬激光碎石术，其中肾盏憩室内结石8例，肾下盏结石[肾盂肾下盏漏斗夹角（IPA）<30°]7例，输尿管软镜治疗失败4例，集合系统无扩张肾结石17例，儿童肾结石4例，乙状结肠直肠膀胱术（Mainz-Ⅱ）术后并发肾结石6例。结石大小<1.5?cm 28例、大小>1.5?cm 18例，结石平均直径（1.6±0.4）cm。位于肾下盏、中盏、上盏、肾盂合并肾盏结石分别为20、10、5和11例。术中均“一针见石”建立经皮肾手术通道后碎石。结果?术中所有患者均采用单通道，35例F4.8可视肾镜钬激光碎石，11例较大铸型结石术中再扩至F20行钬激光或超声碎石清石术，手术时间为25～50?min，平均为（37.4±9.2）min，术后35例完全无管化、11例留置肾造瘘管或双J管，术后所有患者均未出现活动性出血，3例患者出现发热，经常规抗感染治疗后，症状很快消失，术后住院时间为（2.4±0.8）d，术后1个月结石清除率为91.3%（42/46）。4例有残石患者辅助予以体外冲击波碎石、物理振动及药物促进排石治疗，再随访1个月结石均排净。结论?F4.8可视穿刺针式肾镜治疗特殊类型肾结石更加安全有效，成功率高，清石率高，且并发症低，近似无出血手术，患者恢复快，值得临床推广应用。

Abstract:

To investigate the clinical efficacy and safety of micro-percutaneous nephrolithotomy for the treatment of special type of kidney stones.?Methods?From June 2016 to August 2017, 46 patients with special type of nephrolithiasis were treated with holmium laser lithotripsy by F4.8 platinoscopy. Among them, 8 cases were calyceal diverticula calculi, the lower calyceal stones (IPA??1.5?cm, the average diameter of stones is (1.6?±?0.4) cm. Located in the lower calyx, middle and upper calyx, renal pelvis combined with calyceal stones were 20 cases, 10 cases, 5 cases and 11 cases. All surgeries were conducted “one puncture to the stone” establishing a path for percutaneous nephrostomy and then lithotripsy.?Results?All the patients were treated with single channel, 35 cases used F4.8 visual nephrolithotomy holmium laser lithotripsy, 11 cases used larger stag horn calculi surgery and then expanded to F20 conducting holmium laser or ultrasonic lithotripsy, surgery time was 25?~?50?min, with an average of (37.4?±?9.2) min. 35 patients were conducted tubeless PCNL and 11 patients underwent nephrostomy or double J catheterization after surgery. No postoperative bleeding occurred in all patients, and 3 patients developed fever. After conventional anti-infective therapy, the symptoms disappeared quickly. The postoperative hospital stay was (2.4?±?0.8) days and the stone clearance rate was 91.3% (42/46) after one month. 4 cases of residual stone patients assisted with extracorporeal shock wave lithotripsy, physical vibration and drugs to promote passing stones, and then follow-up stones were passed net after one month.?Conclusion?F4.8 micro-percutaneous nephrolithotomy is safer and more effective in treating special types of kidney stones. The success rate of surgery is high, the stone clearance rate is high, the complications are few, so the operation is like no bleeding surgery and the patient recovers very fast. It is worthy of clinical application.