论文部分内容阅读
目的观察分析腹腔镜肾盂切开、肾镜取石术治疗肾多发性结石的效果及其应用价值。方法采用回顾性分析方法回顾本院51例多发性肾结石患者的临床资料,均采用腹腔镜肾盂切开术、肾镜取石术治疗,用腹腔镜取出肾盂结石,对铸型结石难以取出者采用腹腔镜肾盂切开置入肾镜,行胆道碎石取石术后将结石取出。结果 51例手术均成功,结石全部取尽,结石大小1.0cm×1.4cm～2.2cm×3.4cm。手术时间48～131min,平均(86±12)min,术中出血量25～55ml,术后第1～2天可下床活动,术后1～3d肛门排气,术后3～6d拔除后腹腔引流管,术后4～7d拔除留置导尿管,术后1个月门诊经膀胱镜拔除双J管;术后住院4～7d,3例术后发热,体温37.5℃～39.1℃,持续2～4d,无出血、术后尿漏等近期并发症。随访3个月以上,B超、IVU未见输尿管狭窄及结石复发。结论腹腔镜肾盂切开、肾镜取石术治疗多发性肾结石能够良好的暴露肾盂,后腹膜途径能够准确穿刺进入结石所在肾盏,快速定位、准确取石,从而缩短手术时间,术后并发症少,一期结石清除率高,能够大大减少住院天数从而降低住院费用,具有临床推广价值。
Objective To observe and analyze the effect and application value of laparoscopic pyelolithotomy and nephrolithotomy in the treatment of multiple renal stones. Methods The clinical data of 51 patients with multiple nephrolithiasis were retrospectively analyzed retrospectively. Laparoscopic pyelolithotomy, nephrolithotomy and laparoscopy were used to remove the pellacal stones and the stones were difficult to remove Laparoscopic pyelography into the nephrolithotomy, stone removal after biliary lithotripsy. Results All the 51 surgeries were successful. The stone was completely removed. The stone size was 1.0cm × 1.4cm ~ 2.2cm × 3.4cm. The operation time ranged from 48 to 131 minutes with an average of (86 ± 12) min and blood loss from 25 to 55ml. The patients were able to get out of bed on the first or second day after surgery and anus was evacuated 1 to 3 days after operation. After 3 to 6 days after operation, Peritoneal drainage tube, 4 ~ 7d after removal of indwelling catheter, one month after surgery by cystoscopy removed double J tube; postoperative hospital stay 4 ~ 7d, 3 postoperative fever, body temperature 37.5 ℃ ~ 39.1 ℃, sustained 2 ~ 4d, no bleeding, postoperative urinary leakage and other recent complications. Follow-up more than 3 months, B ultrasound, IVU no ureteral stricture and recurrence of stones. Conclusions Laparoscopic pyeloplasty and nephrolithotomy are effective in exposing the renal pelvis to multiple renal calculi. The retroperitoneal approach can accurately puncture the calyces of the calculus, rapidly locate and accurately retrieve stones, shortening the operation time and reducing the postoperative complications , A high rate of stone removal, can greatly reduce the number of hospital days to reduce hospitalization costs, with clinical promotion value.