经皮肾镜联合输尿管软镜治疗孤立肾肾结石的临床分析.doc

精品论文 参考文献 经皮肾镜联合输尿管软镜治疗孤立肾肾结石的临床分析 （滨州医学院烟台附属医院泌尿外科 山东 烟台 264100） 　　【摘要】 目的：探讨经皮肾镜联合输尿管软镜治疗孤立肾肾结石的安全性及有效性。方法：回顾性分析2013年1月～2015年12月采用经皮肾镜联合输尿管软镜治疗的26例孤立肾肾结石患者资料。男18例，女8例。年龄35～72岁，平均46岁。左侧孤立肾17例，右侧孤立肾9例，其中对侧肾萎缩无功能15例(肾小球滤过率lt;10 ml／min) 、对侧肾切除11例。患者均经超声、KUB、CT扫描加三维重建检查确诊，并明确结石的大小及位置。结石最大径（2.4plusmn;1.5）cm，其中鹿角形结石10例，肾多发结石7例，肾单发结石9例，合并输尿管上段结石6例。结石CT值(845.7plusmn;345.2)HU。肾积水17例，集合系统分离1.8～4.2cm，平均2.9cm。结果：26例患者均一期成功取石。手术时间（98plusmn;26）min，住院时间（7.5plusmn;2.5）ｄ。术中出血量约30～100ml，平均52ml。1例术后有明显出血，出血量约450ml，给予夹闭肾造瘘管，对症治疗后出血自行停止，无输血病例。术后当日发热3例，最高体温38.7℃，无寒战，经积极抗感染治疗2～4d后痊愈。其余患者无肾绞痛、肾穿孔、输尿管穿孔、液气胸及周围脏器组织损伤。术后3个月复查，18例术前肾功能正常患者术后肾功能无明显变化，8例术前肾功能不全患者都有不同程度恢复，其中5例恢复正常，3例肾功能较术前好转。一期结石清除率84.6％(22／26)。4例结石残留，其中2例二期手术取净结石，二期结石清除率92.3％(24／26)；2例行ESWL后排出。结论：经皮肾镜联合输尿管软镜治疗孤立肾肾结石具有出血少，创伤小，并发症少、术后恢复快，安全有效，值得临床推广。 　　【关键词】 经皮肾镜；软性输尿管镜；孤立肾；肾结石 　　【中图分类号】R692 【文献标识码】A 【文章编号】2095-1752（2016）26-0135-02 　　Clinical analysis of percutaneous nephrolithotomy combined with flexible ureteroscope treatment of solitary kidney stones 　　Li aiqun, Che jizhong ,Zhang yongfu.Department of Urology,Yantai Hospital Affiliated to Binzhou Medical University,Yantai 264100,China 　　【Abstract】0bjective To investigate the safety and efficacy of percutaneous nephrolithotomy combined with flexible ureteroscopy in treatment of calculi of solitary kidney.Methods A retrospective analysis was carried out on the clinical data of 26 patients with calculi of solitary kidney,who underwent percutaneous nephrolithotomy combined with flexible ureteroscopy from January 2013 to December 2015,Among them,18 cases were male,8 cases were female,with average age of 46 years(range,5-72),Left solitary kidney in 17 cases, right side solitary kidney in 9 cases, of which there was no function of side renal atrophy in 15 cases (glomerular filtration rate lt;10 ml / min), 11 cases of contralateral renal resection. All patients were diagnosed by ultrasound, KUB, CT scan and three dimensional reconstructio