二期经皮肾镜联合输尿管软镜治疗M—PCNL术后残石疗效的临床研究

　　[摘要] 目的 探討二期经皮肾镜联合输尿管软镜处理M-PCNL术后残留结石的有效性及安全性。 方法 回顾性分析2014年6月～2016年12月间86例肾结石患者，采用F18-F20通道一期M-PCNL，使用钬激光或气压弹道碎石，将可及肾盂、肾盏内结石清除，留置双J管及肾造瘘管，术后复查有结石残留。将所有患者分为实验组与对照组，实验组42例，对照组44例。实验组患者术后1周采用半截石斜卧位，分别李逊镜和输尿管软镜进行碎石取石操作。对照组单纯采用经皮肾镜进行碎石取石治疗。 结果 实验组42例残留结石S.T.O.N.E评分（6.9±1.0）分，平均手术时间（52.0±9.4）min，术后结石清除率95.2%（40/42）。对照组44例残留结石S.T.O.N.E评分（8.8±0.5）分，平均手术时间（72.0±8.8）min，术后结石清除率72.7%（32/44），两组比较差异有统计学意义（P<0.05）。 结论 二期经皮肾镜联合逆行输尿管软镜处理M-PCNL术后残留结石安全性高，效果满意。
　　[关键词] 肾结石；输尿管软镜；经皮肾镜；联合治疗
　　[中图分类号] R692.4 [文献标识码] A [c文章编号] 1673-9701（2018）08-0015-04
　　Clinical study of second stage percutaneous nephroscopy combined with ureteroscopy in the treatment of residual stone after M-PCNL
　　LIU Ping1 SUN Shuben1 WANG Jianqiang1 JIANG Liang1 CHEN Haichao1 SHAO Faming1 MIAO Qilong1 REN Yu2
　　1.Department of Urology， the Affiliated Hospital of Medical College of Ningbo University， Ningbo 315000， China； 2.Department of Urology， Ningbo Hospital of Urology and Nephropathy， Ningbo 315000， China
　　[Abstract] Objective To investigate the efficacy and safety of second-stage percutaneous nephroscopy combined with ureteroscopy in the treatment of residual stones after M-PCNL. Methods 86 cases of kidney stones between June 2014 and December 2016 were retrospectively analyzed. F18-F20 channel first stage M-PCNL was applied. Holmium laser or pneumatic lithotripsy was applied， which was able to remove the stones from renal pelvis and calyx. Dual J tube and renal fistula tube were remained. Residual stones were reviewed postoperatively. All patients were divided into the experimental group and the control group， with 42 cases in the experimental group， and 44 cases in the control group. Half recumbent position of stones were applied in the experimental group one week after the surgery. Li Xun scope and ureteroscopy were performed respectively for the operation of stone removal. The control group was given percutaneous nephroscopy for the stone removal alone. Results The S.T.O.N.E score of the residual stones in the 42 cases in experimental group was （6.9±1.0）points， the average operation time was （52.0±9.4）minutes， and the postoperative stone clearance rate was 95.2%（40/42）. The S.T.O.N.E score of the residual stones in the 44 cases in the control group was（8.8±0.5）points， the average operation time was（72.0±8.8）minutes， and the postoperative stone clearance rate was 72.7% （32/44），the difference between the two groups was statisitically significant（P<0.05）. Conclusion The second stage percutaneous nephroscopy combined with retrograde ureteroscopy in the treatment of residual stones after M-PCNL surgery is safe and satisfactory.

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