经皮肾镜气压弹道联合超声碎石术的安全性及疗效分析

目的 评价经皮肾镜下气压弹道联合超声碎石术治疗肾结石的临床疗效及安全性。方法 自2003年9月至2005年8月,采用经皮肾镜下气压弹道联合超声碎石术治疗486例509侧肾结石患者,对其临床资料进行回顾性分析。结果 478例患者成功建立20．8-24F皮肾通道并Ⅰ期碎石,6例患者Ⅱ期碎石,2例因出血改开放手术。平均手术时间73min,平均结石处理时间为41min。本组未出现气胸、肠道损伤等手术并发症。术后复查KUB平片,438侧肾脏结石清除干净,净石率86．1％;71侧肾脏有结石残留,行二次肾镜取石,或辅助体外冲击波碎石治疗。结论 经皮肾镜下气压弹道联合超声碎石术处理肾结石具有高效、安全的特点,值得临床推广应用。

Analysis of clinical efficacy and safety of combining pneumatic and ultrasonic power in percutaneous nephrolithotomy (PCNL) for renal stones

OBJECTIVE: To investigate the clinical efficacy and safety of combining pneumatic and ultrasonic power during PCNL. METHODS: From Sep 2003 to Aug 2005, we treated 486 patients (509 kidneys) by combining pneumatic and ultrasonic power during percutaneous nephrolithotomy. Clinical data were analyzed retrospectively. RESULTS: The percutaneous renal access was successfully established in 478 patients under ultrasound guidance and immediate phase I lithotripsy was performed, and delayed phase II lithotripsy was performed for 6 patients. Average time required for entire procedure is 73 mins, and average time for stone management is 41 mins. No severe complications occurred. No Residual stone fragment in 438 kidneys, stone free rate was 86.1%. Residual stone fragment was found in 71 kidneys by postoperative KUB and received second PCNL or adjuvant ESWL. CONCLUSION: The combined application of pneumatic and ultrasonic power in PCNL appears to be efficacious and safe for disintegrating and removing renal calculi.