Objective To evaluate the efficacy of single-tract minimally invasive percutaneous nephrolithotomy (MNPC-NL) combined with flexible ureteroscopy in the treatment of complex kidney stones .Methods We retrospectively reviewed the data of 78 cases undergoing single-tract MNPCNL and flexible ureteroscopy ,35 of which were staghorn or big stones (>2.5 cm) ,and the others were multiple kidney stones .All patients were examined with KUB or renal CT scan .Residual stones≥4 mm were regarded as clinically significant .Results Up to 85 .9% (67/78) of the patients in the observation group recov-ered in the first stage ,and the average operation time was (92 ± 18) min .The average operation time of the second stage was (46 ± 11) min ,and the total clearance rate reached 94 .9% (74/78) .4 cases had residual calculi 0 .4~0 .9 cm and underwent subsequent extracorporeal shock wave lithotripsy (ESWL) ,3 of which were stone-free after 3 to 6 months .Compared with the control group ,the differences were significant .Conclusions Single-tract minimally invasive percutaneous nephrolithotomy combined with flexible ureteroscopy is effective and safe in the treatment of complex kidney stones .It has advantages of short operation time ,small surgical trauma ,few complications ,and high stone-free rate .%目的 探讨单通道微创经皮肾镜钬激光碎石术联合输尿管软镜钬激光碎石术治疗复杂性肾结石的手术效果.方法 回顾性分析我科使用单通道微创经皮肾镜联合输尿管软镜钬激光碎石术治疗复杂性肾结石78例.其中铸型结石或大结石(>2 .5 cm )35例 ,肾盂肾盏多发性结石43例.手术采用B超引导下单通道微创经皮肾镜(F16/F18 )及输尿管软镜配合钬激光方式进行.术后复查尿路平片或双肾CT评估手术效果 ,残留结石≥4 mm为临床有意义的结石残留.结果 观察组所有手术均成功建立经皮肾工作通道碎石取石 ,其中76例一期联合输尿管软镜处理残留结石 ,2例行二期手术.一期手术平均时间为(92 ± 18 ) min ,结石清除率为85 .9% (67/78);二期手术平均时间为(46 ± 11)min ,结石总清除率94 .9% (74/78).4例患者残留结石 ,大小约0.4~0.9cm,给于体外碎石治疗 ,术后随访3~6个月 ,结石清除3例.78例患者均未出现气胸、肠道损伤、输尿管黏膜撕脱、输尿管断裂、大出血或脓毒血症等严重并发症.与对照组相比差异有统计学意义(χ2 =4 .047 ,P<0 .05 ).结论 单通道微创经皮肾镜联合输尿管软镜治疗复杂性肾结石具有手术时间短、创伤小、并发症少、结石清除率高等优点 ,具有良好的有效性和安全性 ,值得临床广泛推广.
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