Cui Zhenyu, Gao Yanjun, Yang Wenzeng, Zhao Chunli, Ma Tao, Shi Xiaoqiang
Zhenyu Cui, Department of Urinary Surgery, Affiliated Hospital of Hebei University, Baoding 071000, P. R. China.
Yanjun Gao, Department of Urinary Surgery, Affiliated Hospital of Hebei University, Baoding 071000, P. R. China.
Pak J Med Sci. 2018 Jan-Feb;34(1):110-114. doi: 10.12669/pjms.341.14236.
To evaluate the therapeutic effects of visual standard channel combined with F4.8 visual puncture super-mini percutaneous nephrolithotomy (SMP) on multiple renal calculi.
The clinical data of 46 patients with multiple renal calculi treated in Affiliated Hospital of Hebei University from October 2015 to September 2016 were retrospectively analyzed. There were 28 males and 18 females aged from 25 to 65 years old, with an average of 42.6. The stone diameters were 3.0-5.2 cm, (4.3 ± 0.8) cm on average. F4.8 visual puncture-assisted balloon expansion was used to establish a standard channel. After visible stones were removed through nephroscopy combined with ultrasound lithotripsy, the stones of other parts were treated through F4.8 visual puncture SMP with holmium laser. Indices such as the total time of channel establishment, surgical time, decreased value of hemoglobin, phase-I stone clearance rate and surgical complications were summarized.
Single standard channel was successfully established in all cases with the assistance of F4.8 visual puncture, of whom 24 were combined with a single microchannel, 16 were combined with double microchannels, and six were combined with three microchannels. All patients were placed with nephrostomy tube which was not placed in the microchannels. Both F5 double J tubes were placed after surgery. The time for establishing a standard channel through F4.8 visual puncture was (6.8 ± 1.8) min, and that for establishing a single F4.8 visual puncture microchannel was (4.5 ± 0.9) min. The surgical time was (92 ± 15) min. The phase-I stone clearance rate was 91.3% (42/46), and the decreased value of hemoglobin was (12.21 ± 2.5) g/L. There were 8 cases of postoperative fever which was relieved after anti-inflammatory treatment. Four cases had 0.5-0.8 cm of stone residue in the lower calyx, and all stones were discharged one month after surgery by shock wave lithotripsy combined with position nephrolithotomy, without stone streets, delayed bleeding, peripheral organ damage or urethral injury.
Combining visual standard channel with F4.8 visual puncture SMP for the treatment of multiple renal calculi had the advantages of reducing the number of large channels, high rate of stone clearance, safety and reliability and mild complications. The established F4.8 visual puncture channel was safer and more accurate.
评估可视标准通道联合F4.8可视穿刺超微通道经皮肾镜取石术（SMP）治疗多发肾结石的疗效。
回顾性分析2015年10月至2016年9月在河北大学附属医院治疗的46例多发肾结石患者的临床资料。其中男性28例，女性18例，年龄25～65岁，平均42.6岁。结石直径3.0～5.2 cm，平均（4.3±0.8）cm。采用F4.8可视穿刺辅助球囊扩张建立标准通道。经肾镜联合超声碎石清除可见结石后，采用F4.8可视穿刺SMP联合钬激光处理其他部位结石。总结通道建立总时间、手术时间、血红蛋白下降值、一期结石清除率及手术并发症等指标。
所有病例均在F4.8可视穿刺辅助下成功建立单标准通道，其中24例联合单微通道，16例联合双微通道，6例联合三微通道。所有患者均留置肾造瘘管，微通道未留置。术后均留置F5双J管。F4.8可视穿刺建立标准通道时间为（6.8±1.8）min，建立单F4.8可视穿刺微通道时间为（4.5±0.9）min。手术时间为（92±15）min。一期结石清除率为91.3%（42/46），血红蛋白下降值为（12.21±2.5）g/L。术后发热8例，经抗炎治疗后缓解。4例下盏残留结石0.5～0.8 cm，术后1个月均经冲击波碎石联合体位肾镜取石排出结石，无石街、延迟出血、周围器官损伤及尿道损伤。
可视标准通道联合F4.8可视穿刺SMP治疗多发肾结石具有减少大通道数量、结石清除率高、安全可靠、并发症轻等优点。建立的F4.8可视穿刺通道更安全、准确。
