[摘要] 目的 探討二期經皮腎鏡聯合輸尿管軟鏡處理M-PCNL術后殘留結石的有效性及安全性。 方法 回顧性分析2014年6月～2016年12月間86例腎結石患者，采用F18-F20通道一期M-PCNL，使用鈥激光或氣壓彈道碎石，將可及腎盂、腎盞內結石清除，留置雙J管及腎造瘺管，術后復查有結石殘留。將所有患者分為實驗組與對照組，實驗組42例，對照組44例。實驗組患者術后1周采用半截石斜臥位，分別李遜鏡和輸尿管軟鏡進行碎石取石操作。對照組單純采用經皮腎鏡進行碎石取石治療。 結果 實驗組42例殘留結石S.T.O.N.E評分（6.9±1.0）分，平均手術時間（52.0±9.4）min，術后結石清除率95.2%（40/42）。對照組44例殘留結石S.T.O.N.E評分（8.8±0.5）分，平均手術時間（72.0±8.8）min，術后結石清除率72.7%（32/44），兩組比較差異有統計學意義（P<0.05）。 結論 二期經皮腎鏡聯合逆行輸尿管軟鏡處理M-PCNL術后殘留結石安全性高，效果滿意。
　　[關鍵詞] 腎結石；輸尿管軟鏡；經皮腎鏡；聯合治療
　　[中圖分類號] R692.4 [文獻標識碼] A [c文章編號] 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.

相關熱詞搜索：輸尿管 術后 二期 療效 臨床研究