经皮肾镜气压弹道超声联合碎石治疗复杂性肾结石

目的探讨超声定位引导下经皮肾镜气压弹道超声联合碎石术治疗复杂性肾结石的安全性及其疗效。方法回顾分析经皮肾镜气压弹道超声联合碎石取石术治疗复杂性肾结石289例共312侧的临床资料。结果经皮肾镜碎石一期手术276侧,平均手术时间76 min,平均出血75 ml,结合体外冲击波碎石,一期单侧结石清除率88.5%,36侧行二期手术。结肠损伤1例,术后大出血13例,需肾动脉栓塞止血3例,发热63例,严重感染3例,术后平均住院8d。无肾切除、中转开放及肾功能不全。结论超声定位引导下经皮肾镜气压弹道超声联合碎石术是治疗复杂性肾结石的最佳选择,具有损伤小,康复快,住院时间短,结石清除率高等优点。

Combined pneumatic and ultrasound lithotripsy in percutaneous nephrolithomy for complicated renal calculi

Objective To investigate the safety and efficacy of combined pneumatic and ultrasound lithotripsy for complicated renal calculi by B-type ultrasound guidance in percutaneous nephrolithomy.Methods Two hundred and eighty nine cases(312 sides),who were treated by percutaneous nephrolithotripsy of using pneumatic and ultrasonic system(EMS Ⅳ),were reviewed retrospectively.Results Two hundred and seventy six sides were performed on stage Ⅰ.The mean time of the operation was 76 minutes.The average blood loss was 75ml.With the treatment of ESWL,the first calculi clearance rate was 84.3%.36 sides were performed on stage Ⅱ.There were one cases with colon injure,13 patients with severe hemorrhage after operation while 3 cases were cured by selectivity thrombosis of renal artery;63 patients had severe fever after operation and 3 cases had severe infection.There were no nephrectomy,transferring to open operation and renal dysfunction.The average lengths of stay after operation were 8 days.Conclusion The combined pneumatic and ultrasound lithotripsy in percutaneous nephrolithomy by B-type ultrasound guidance for complicated renal calculi have the advantage of small wound,rapid recovery,shorter hospital time and higher calculi clearance.It is a better choice for the treatment of complicated renal calculi.