B超引导经皮肾镜下气压弹道联合超声碎石术治疗复杂性输尿管上段结石

目的探讨B超引导经皮肾镜下气压弹道联合超声碎石术治疗复杂性输尿管上段结石的临床疗效。方法复杂性输尿管上段结石患者68例,男36例,女32例,平均年龄42岁(19岁～70岁)。均行B超、CT检查,KUB+IVU检查28例,逆行肾盂造影检查9例。结石直径1.0～4.3cm。单发62例,多发6例。左侧29例,右侧27例,双侧12例。合并患侧肾积水65例,泌尿系感染36例,肾功能不全7例,其中氮质血症期4例,尿毒症前期3例。均采用B超引导经皮肾镜下第三代气压弹道超声碎石清石系统治疗并观察分析。结果 68例80侧均1期建立24F经皮肾通道并碎石成功。平均手术时间65min,术后平均住院时间5d,结石清除率为100%。术中无气胸、腹腔脏器损伤等严重并发症发生。术后随访1～3月拔除输尿管内双J管。术前肾功能不全的7例患者,术后1月复查5例血肌酐值恢复正常,46例获随访3～24个月,无结石复发。结论 B超引导穿刺经皮肾镜下气压弹道联合超声碎石输尿管上段结石效率高、并发症少,是治疗复杂性输尿管上段结石的较好方法,特别对ESWL及输尿管镜碎石失败的病例。

Percutaneous nephrolithotripsy with pneumatic and ultrasonic power under B-type ultrasound guidance for treatment of complex upper ureteral calculi

【Objective】To evaluate the clinical efficacy and experiment of management of complex upper ureteral stone by percutaneous nephrolithotripsy（PCNL） with pneumatic and ultrasonic power under B-type ultrasound guidance.【Methods】We retrospectively investigated 68 cases（36 males,32 females,19 ～ 70 years） who underwent PCNL using the third generation Swiss LithoClast Master for complex upper ureteral stone from 2004 to 2007.Clinical data including operation time,stone free rate and complications were analyzed.【Results】The 24F percutaneous renal access was successfully established under B type ultrasound guidance and immediate phaseⅠlithotripsy was performed in all patients.Average operation time was 65 minutes and arerage hospitalization duration was 5 days after operation.Severe complication did not occur during nephrolithotripsy.Stone free rate was 100%.Follow-up of 3 to 36 months for 46 cases showed good results and no recurrence.【Conclusions】PCNL with pneumatic and ultrasonic power under B type ultrasound guidance is efficient and causes less complication,thus suitable for treatment of complex upper ureteral stone,especially for the cases that have failed ESWL or ureteroscopy.