复杂性肾结石的经皮肾镜气压弹道超声碎石治疗

目的：探讨经皮肾镜气压弹道超声碎石术治疗复杂性肾结石的有效性及安全性。方法：对接受经皮肾镜气压弹道超声碎石术的55例复杂性肾结石患者资料行回顾性分析，其中单发肾盂、肾盏结石25例，多发结石18例，鹿角形结石12例，双侧结石7例。结石长径3～7cm，采用B超定位建立经皮肾镜操作通道，EMS第j代气压弹道超声碎石机用于粉碎并清除结石。结果：除1例脓肾作肾造瘘，二周后手术外，其他病例均单通道一期完成手术。手术时间90～180min，平均120min。术中出血量100～700ml，平均200ml。结石一次取净率70.9％（39／55），残留结石16例，其中泥沙样结石7例，术后自行排净，残留小结石9例，术后ESWI。1～2次，结石完全排净。1例脓肾患者行二期手术，术后大出血，改开放手术作肾切除。全部病例随访1～22个月，无严重出血或肾功能损害等并发症。结论：微创经皮肾镜气压弹道超声碎石术治疗复杂性肾结石具有结石清除率高、安全的特点，值得临床推广。

Percutaneous nephroscopic lithoclast and ultrasound lithotripsy for complicated renal calculi

Objective:To evaluate the efficiency and safety of combined lithoclast and ultrasound lithotripsy for the treatment of complicated renal calculi.Methods:From August 2004 to June 2006,we retrospectively investigated 55 patients suffering from complicated renal calculi,who were treated with combined lithclast and ultrasound lithotripsy during percutaneous nephroscopy.Pelvocalyceal calculi were noted in 25 cases,multiple renal calculi in 18,staghorn calculi in 12,bilateral renal calculi in 7.Longitudinal size of calculi was 3-7 cm.Working channel for percutaneous nephroscopy was established under the guidance of B-ultrasonography.Renal stones were fragmented and extracted by using the LithoClastMaster(EMS,Switzerland).Results:All cases except a pyonephrosis were underwent one-stage minimally invasive percutancous nephrolithotomy by single tract.The average time for whole surgery was 120 minutes.Average volume of blood loss was 200 ml.The stone clearance rate was 70.9%.During the follow-up period of 1 to 22 months,no severe complications,such as hemorrhage or renal function deterioration,were observed.Conclusions:The combined lithclast and ultrasonic device is safe and effective for the treatment of complicated renal calculi.