标准通道经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石的效果观察简

目的 评价标准通道经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石的效果和安全性.方法 选择2011年4月～2013年3月复旦大学附属中山医院青浦分院采用经皮肾镜下气压弹道联合超声碎石清石系统治疗的复杂性肾结石患者70例（71侧）,对其临床资料进行回顾性分析.结果 Ⅰ期手术60例（61侧）,Ⅱ期手术9例（9侧）,Ⅲ期手术1例（1侧）;单通道取石66例（67侧）,双通道取石4例（4侧）.手术时间53～115 min,平均71 min.术后2个月复查,结石总取尽率78.9％ （56/71）,其中Ⅰ期取尽率66.2％ （47/71）,Ⅱ期11.3％ （8/71）,Ⅲ期1.4％（1/71）.5例术中发现肾盂尿脓性,均在低压灌注下Ⅰ期碎石,术后未出现感染性休克;2例术后4～5 d继发大出血,1例保守治疗后好转,1例行介入治疗后治愈;1例出现肠穿孔,禁食2周,肠内外营养对症支持等保守治疗后痊愈;1例发生输尿管中下段石阶,保留肾造瘘管2周,术后第10天行输尿管镜下取石术;未发生感染性休克、胸膜损伤、肾蒂损伤等其他严重并发症.平均住院时间8.5 d.结论 标准通道经皮肾镜下气压弹道联合超声碎石术治疗复杂性肾结石具有创伤小、安全、高效等优势,但术前需更完善的准备,注意预防严重并发症.

Combination of percutaneous pneumatic nephrolithotripsy and ultrasound lithotripsy through a standard channel treating complicated renal calculi

Objective To evaluate the efficacy and safety of standard channel-guided percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy for the treatment of complex renal calculi.Methods From April 2011 to March 2013 in Qingpu Branch Hospital of Affiliated Zhongshan Hospital of Fudan University,70 cases （71 kidneys） of renal calculi were treated by percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy.Clinical data were retrospectively analyzed.Results The percutaneous renal access was successfully established in 60 cases （61 kidneys） under ultrasound guidance,immediate phase Ⅰ lithotripsy was performed,phase Ⅱ and phase Ⅲ lithotripsy was performed for 9 cases （9 kidneys） and 1 case （1 kidney）.Single-tract procedure was performed on 66 cases （67 kidneys）,while double-tracts were was performed on 4 cases （4 kidneys）.The operation time ranged from 53 to 115 minutes with a mean of 71 minutes.The total stone clearance rate was 78.9 ％ （56/71） in two months after the operation,while this of phase Ⅰ was 66.2 ％ （47/71）,this of phase Ⅱ was 11.3 ％ （8/71）,this of phase Ⅲ was 1.4％ （1/71）.During the operation,renal pelvic urine pus happened in 5 patients.Those stones were treated successfully in phase Ⅰ under a low-pressure perfusion,while septic shock didn＇t occur after surgery.2 cases showed hemorrhage severely in 4-5 days after the operation,1 patient was better after conservative treatment,the other was cure after ultra-selective arterial embolization.1 case appeared intestinal perforation,was cured by given fasting for 2 weeks,enteral and parenteral nutritional support as conservative treatment.1 case of ureteral ＇stone steps＇ was treated by ureteroscopic lithotomy on the tenth day after operation,and retained the renal fistula for 2 weeks.No septic shock,pleural damage,kidney pedicle damage,and other serious complications were found during the period.The average hospital stay was 8.5 days.Conclusion Standard channel-guided percutaneous pneumatic nephrolithotripsy combined with ultrasonic lithotripsy for the treatment of complicated renal calculi is safe,effective,and minimally invasive.And a better preparation is necessary before operation to prevent serious complications.