经皮肾镜气压弹道联合超声碎石治疗复杂性肾结石

目的探讨经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石的方法及疗效.方法 B超引导下穿刺并扩张建立F24经皮肾镜操作通道.在F20.8肾镜下采用瑞士EMS Ⅲ代气压弹道联合超声碎石机,Ⅰ期粉碎结石并主动吸出体外.结果单侧结石清除时间5～115 min,平均35 min.结石粉碎率100%,结石取净率91.8%(45/49).术后4～6 d拔除肾造瘘管,拔除肾造瘘管2 d后拔除导尿管,术后1个月拔除双J管.术后住院6～12 d,平均8 d.4例肾盏内或输尿管上段残留结石,直径＜1 cm,术后3周行体外冲击波碎石1～2次,均顺利排出体外.49例随访1～6个月,平均3.2月,均无严重出血及感染,无结石复发.结论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高效、安全的特点,值得临床推广应用.

Percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi

Objective To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods Under the guidance of B-ultrasonography,a F_(24) working channel for percutaneous nephroscopy was established.Renal stones were fragmented and extracted under a F_(20.8) nephroscope by using the LithoClast Master(EMS,Switzerland).Results The time for unilateral complete stone clearance was 5~115 min(mean,35 min).All the stones were successfully fragmented and the stone clearance rate was 91.8%(45/49).The renal fistulization tube was removed at 4~6 days after operation and the urethral catheter was removed 2 days afterwards.The double-J tube was removed at 1 month after operation.The postoperative hospital stay was 4~6 days(mean,8 days).Residual stones < 1 cm in diameter in the renal calyx or upper ureter were found in 4 cases and were later cured by extracorporeal shock wave lithotripsy(ESWL) for 1~2 times at 3 weeks after operation.No severe hemorrhage,infection or recurrence was observed during a follow-up for 1~6 months(mean,3.2 months) in the 49 cases.Conclusions Percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi is effective and safe.