B超与X线定位微创经皮肾取石术治疗上尿路结石的随机对照研究

目的:比较B超与X线定位微创经皮肾取石术治疗上尿路结石的临床疗效。方法:选取2010年3月到2012年9月我院收治的上尿路结石患者190例,按照随机数字表法将患者分为研究组和对照组,每组95例;对照组给予X线定位微创经皮肾取石术,研究组给予B超定位微创经皮肾取石术治疗,两组再分为肥胖组和正常体型组;比较各组结石清除率、手术时间、术中出血量、住院时间、并发症发生率及穿刺定位时间。结果:研究组一期结石清除率高于对照组,两组比较差异具有统计学意义(X2=10.751,P=0.024);研究组手术时间、术中出血量、住院时间均显著优于对照组,两组比较差异具有统计学意义(t=9.214,9.013,10.012,P=0.012,0.015,0.009);两组均无严重并发症发生,并发症发生率比较无统计学意义(X2=3.120,P=0.120),研究组中肥胖组定位时间明显长于正常体型组,差异有统计学意义(t=22.939,P=0.003),也长于对照组的肥胖组,差异有统计学意义(t=10.979,P=0.009)。结论:B超定位微创经皮肾取石术治疗上尿路结石具有较好的效果,结石的清除率高,对患者危害小,有利于患者康复。对于肥胖患者,B超定位相对于X线定位无优势。     

微创经皮肾穿刺碎石术（MPCNL）治疗上尿路结石的临床分析

目的：探讨微创经皮肾穿刺碎石术（MPCNL）用于治疗尿路结石的临床效果。方法：选取120例单侧上尿路结石病患者,随机分为两组,每组60人。一组应用微创经皮肾穿刺碎石术（MPCNL）进行一期单通道上尿路取石,另一组采用开放手术治疗。比较并分析两组患者的临床疗效。结果：应用MPCNL治疗的60名患者中,结石清除的有55名,清除率为91．17％,手术时间平均为77分钟,住院时间平均为5-3天。术中平均出血100mL,术后发生大出血者一例,经输血后好转,术后发热者38例,发热比例为63-3％,尿液转清时间平均为2．5天。应用开放式手术的60名患者中,结石清除的有39例,清除率为65．0％,平均手术之间为112分钟,住院时间平均为18．1天,术中平均出血380mL,术后发生大出血者9例,经输血后好转,术后发热者43例,发热比例为71．2％,尿液转清时间平均为8．6天。结论：MPCNL方法治疗上尿路结石的效果明显比开放式手术好,具有清除率高、手术时间短、术后并发症少、术后感染少以及患者恢复快的优点。     

侧卧位经皮肾微造瘘输尿管镜下取石治疗上尿路结石56例报道

目的:探讨侧卧位施行经皮肾微造瘘输尿管镜下取石(MPCNL)治疗上尿路结石方法及疗效。方法:回顾分析56例上尿路结石侧卧位施行PCNL治疗的临床资料,其中肾铸形结石33例,输尿管上段结石23例。结果:56例均手术成功,无穿刺失败或中转开放手术。一次结石取净率80%,两次手术合计达96%。术中均无输血,无肠道损伤等并发症。结论:侧卧位施行MPCNL手术患者易耐受,手术更安全,术中碎石易排出。效果良好。     

微创经皮肾镜碎石取石术治疗特殊肾结石的临床疗效观察

目的：研究微创经皮肾镜碎石取石术治疗特殊鹿角型或多发肾结石中的临床疗效和安全性。方法：回顾性分析2007年1月-2013年3月我院收治的37例采用微创经皮肾镜碎石取石术（PCNL）手术方式治疗的特殊鹿角形或多发肾结石患者的临床资料。结果：37例患者中,孤立肾9例、马蹄肾7例、海绵肾和多囊肾7例、儿童患者14例。成人结石直径（3．2±0．3）cm,儿童结石直径（2．2±0．2）cm。37例患者均一期单通道情况下顺利完成手术,单次手术成功率100％,结石清除率91．2％（34／37）,平均手术时间（94±21．6）min,平均出血量（62±12．3）mL,术后1月复查B超提示肾脏积水减轻,肾脏功能血肌酐较术前降低,术后一月复查KUB提示3例肾脏下盏少量残留结石,4例患者出现术后低热症状。结论：采用PCNL治疗特殊鹿角形或多发肾结石的安全性好、结石清除率高、并发症较少。     

侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石的临床应用价值

目的：探讨侧卧体位下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石的可行性及临床应用价值。方法：回顾性分析2009年8月至2011年9月我院采用侧卧体住下经皮肾穿刺取石术联合经尿道输尿管镜取石术治疗复杂上尿路结石患者52例的临床资料：患者同时存在肾脏铸型结石或多发结石和或输尿管上段结石,单个结石最大径8-30mm。结果：平均手术时间60分钟（50—120分钟）;术前血红蛋白116±30g／L,术后第一天复查105±26g／L,无大出血需要输血病例;一次结石取净率为86．5％（45／52）,总取净率为92．3％（48／52）。结论：侧卧体位下经皮肾穿刺取石术及经尿道输尿管镜取石术两种术式联合应用具有可行性及互补性,在预防及减少术中出血、获得清晰的手术视野、减少灌注液外渗、增加结石清除速度及碎石成功率、缩短手术时间、减少术后发热等方面疗效显著,为治疗复杂上尿路结石提供了一个可行的新方法。     

微创经皮肾镜碎石术治疗输尿管上段嵌顿结石

目的:分析微创经皮肾镜碎石术(minimal invasive percutaneous nephrolithotomy,mPCNL)治疗输尿管上段嵌顿性结石的临床疗效.方法:采用B超或X线定位,mPCNL治疗102例嵌顿性输尿管上段结石,其中2例经皮穿刺抽吸脓性尿液,留置造瘘管,抗炎治疗后二期手术.术后生命体征、B超和尿路平片(kindey ureter bladder,KUB)等检查并随访.结果:100例Ⅰ期穿刺成功并气压弹道或钬激光mPCNL,手术时间55-75 min.碎石、取石时间15-35 min.术后住院4-7 d.无穿刺损伤腹腔脏器、术中未有肾孟穿孔和输尿管损伤、无大出血等术中和术后并发症.mPCNL术后2 dKUB检查结石清除率为91.1%(93/102),9例残留结石,术后辅以体外冲击波碎石治疗.术后1个月结石清除率为100%(102/102).结论:微创经皮肾穿刺取石治疗嵌顿性输尿管上段结石创伤小、恢复快且有很高的清除率,值得临床推广应用.     

输尿管软镜结合输尿管硬镜治疗复杂上尿路结石的效果评价及对预后的影响

目的 探讨输尿管软镜协同输尿管硬镜治疗复杂上尿路结石的临床效果.方法 选择我院收治的复杂上尿路结石患者96例,按入院顺序分为对照组和观察组,每组48例.对照组采取输尿管硬镜钬激光碎石术治疗,观察组采取输尿管软镜协同输尿管硬镜钬激光碎石术治疗.比较两组患者1次性碎石成功率、结石彻底清除率、炎症反应情况以及生活质量、住院时...     

输尿管软镜下激光碎石术在上尿路结石治疗中的应用

随着医疗设备的日新月异,在众多医学领域中,微创技术正逐步取代传统的开放手术。输尿管软镜作为泌尿微创腔镜技术的重要组成,在泌尿外科疾病的诊断和治疗中发挥着越来越重要的作用。输尿管软镜下激光碎石术治疗上尿路结石具有创伤小、安全性高、疗效确切、病人恢复快、并发症少的优点,尤其适用于出血体质、过度肥胖、因解剖特点预期ESWL效果不佳、结石体积较小以及肾盏无明显积水的患者。钬激光的使用是此项技术得以广泛应用的重要因素。当激光光纤直径小于0.4 mm时,钬激光对组织损伤最小,激光可以很快被水吸收,这些特点可以保证结石被充分击碎。该方法治疗上尿路结石并发症低、结石排净率高,可以作为体外冲击波碎石失败和经皮肾镜碎石术后残留结石的治疗选择,为熟悉内镜操作并熟练掌握钬激光碎石技术的泌尿外科医师治疗上尿路结石提供了安全有效的方法。本文就输尿管软镜下激光碎石术治疗上尿路结石作了具体的整理与分析。     

微创经皮肾镜取石术治疗输尿管上段结石合并轻度肾积水疗效观察

目的探讨微创经皮肾镜取石术治疗输尿管上段结石合并轻度肾积水的临床疗效。方法选取我院收治的140例输尿管上段结石合并轻度肾积水患者为研究对象,将患者随机分为对照组和观察组各70例,对照组70例行经后腹腔镜输尿管、肾盂切开取石术治疗,观察组行微创经皮肾镜取石术治疗,比较两组患者的治疗效果。结果两组患者在手术时间、术中出血量、胃肠道功能恢复时间及住院时间、血清炎性因子水平方面比较,观察组均明显优于对照组(P0.05);观察组患者的结石清除率与对照组比较,差异无统计学意义(P0.05)。结论输尿管上段结石合并轻度肾积水患者实施微创经皮肾镜取石术治疗的效果显著,有利改善患者血清炎性因子水平,值得推广应用。     

上尿路结石患者行经皮肾镜手术术后发热的影响因素研究

目的:探讨经皮肾镜取石术(PCNL)治疗上尿路结石术后发热的影响因素。方法:回顾性分析在我院行经PCNL治疗的89例上尿路结石患者的病例资料,分别对患者的性别、年龄、术前肾积水的程度、结石的大小、尿培养的结果、手术持续的时间以及术中灌注液等情况进行分析,探讨其与PCNL术后发生发热的相关性。结果:本组资料中,发热(38℃)人数为19人,占21.3%。其中,术前尿培养阳性、结石直径大于3 cm、合并中度及中度以上肾积水、手术持续时间长、灌注液用量多的上尿路结石患者PCNL术后发热的几率明显升高(P0.05)。而年龄、性别与上尿路结石患者PCNL术后发热的几率无明显相关性(P0.05)。结论:术前预防性应用广谱抗生素、术中低压灌注、缩短手术时间、术前穿刺引流等都是预防上尿路结石患者PCNL术后发生发热的有效措施。     

Clinical comparison of extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy in treating renal calculi.

STUDY OBJECTIVE: To compare extracorporeal shock wave lithotripsy and percutaneous nephrolithotomy for efficacy in treating renal calculi. DESIGN: Non-randomised multicentre cohort study with 3 month follow up and 13 month data collection period. SETTING: Lithotripter centre in London, tertiary referral hospital, and urological clinics in several secondary and tertiary care centres. PATIENTS: 933 of 1001 patients treated by lithotripsy at the lithotripter centre were compared with 195 treated by nephrolithotomy. Missing patients were due to incomplete collection of data. Age and sex distributions and characteristics of the stones were similar in the two treatment groups. Two patients died in the lithotripsy group. Three month follow up was achieved in about 84% of both groups (783/933 for lithotripsy; 163/195 for nephrolithotomy). INTERVENTIONS: The nephrolithotomy group had surgical nephrolithotomy alone. In the lithotripsy group 83% (774/933) had lithotripsy alone, 11% (103/933) had combined lithotripsy and nephrolithotomy, and 6% (56/933) had lithotripsy plus ureteroscopy. Single and combined lithotripter treatments were analysed as one group and compared with nephrolithotomy. END POINT: Presence of stones three months after treatment. MEASUREMENTS AND MAIN RESULTS: Presence of residual stones was assessed by plain radiography, ultrasonography, or intravenous urography. After adjustment for age and size and position of stone for patients with single stones the likelihood of being free of stones three months after treatment was significantly greater in the nephrolithotomy group than the lithotripsy group (odds ratio 6.6; 95% confidence interval 3.0 to 14.6) and the response was particularly pronounced with staghorn calculi (62% (8/13) v 15% (141/96) patients free of stones after nephrolithotomy and lithotripsy, respectively). OTHER FINDINGS: 19%(146/775) of patients who had had lithotripsy had to be readmitted within three months after treatment compared with 14%(23/162) who had nephrolithotomy; and 64%(94/146) of readmissions after lithotripsy were for complications compared with 30%(7/23) of readmissions after nephrolithotomy. CONCLUSIONS: Nephrolithotomy may be preferable to lithotripsy for treating renal stones and it may not be wise to invest heavily in lithotripsy facilities.     

Drug-induced urinary calculi

Urinary calculi may be induced by a number of medications used to treat a variety of conditions. These medications may lead to metabolic abnormalities that facilitate the formation of stones. Drugs that induce metabolic calculi include loop diuretics; carbonic anhydrase inhibitors; and laxatives, when abused. Correcting the metabolic abnormality may eliminate or dramatically attenuate stone activity. Urinary calculi can also be induced by medications when the drugs crystallize and become the primary component of the stones. In this case, urinary supersaturation of the agent may promote formation of the calculi. Drugs that induce calculi via this process include magnesium trisilicate; ciprofloxacin; sulfa medications; triamterene; indinavir; and ephedrine, alone or in combination with guaifenesin. When this situation occurs, discontinuation of the medication is usually necessary.     

标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石

目的:探讨标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石的疗效及安全性.方法:总结2009年4月-2009年12月采用标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石36例39侧临床资料.结果:本组35例38侧成功行Ⅰ期PCNL,手术时间30-180min(平均86±34min),出血约30-500ml(平均110±20ml).其中8例残留结石大于1.0cm,术后5-7天行局麻下二期手术清除残石,总结石清除率92.1%(35/38),ESWL治疗3例.1例孤立肾铸型结石并肾积水、肾功能不全,经皮肾穿刺置入F8单J管引流,二期行标准通道PCNL术.所有病例随访1-3月,无严重手术并发症.结论:标准通道经皮肾输尿管镜气压弹道碎石术治疗复杂肾结石,具有安全、效率高、创伤小、恢复快的特点,并可明显减低医疗成本.     

瑞士EMS第四代碎石清石系统治疗复杂性肾结石(附52例报告)

目的:探讨经皮肾镜下应用瑞士EMS第四代碎石清石系统治疗治疗复杂性肾结石的临床效果和操作体会.方法:总结分析我院应用经皮肾镜取石术(PCNL),结合瑞士EMS第四代碎石清石系统治疗治疗复杂性肾结石52例的临床资料.结果:47例均成功行一期取石术,2例需二期PCNL清石,3例需ESWL.手术时间74±26分钟,失血量0.61±0.59 g/L,残石率14.4%±9.3%.3例术后大出血,术中未见严重并发症.结论:瑞士EMS第四代碎石清石系统整合气压弹道碎石与超声碎石技术,处理复杂肾结石安全高效.