经皮肾镜气压弹道联合超声碎石术治疗儿童肾结石

目的 探讨经皮肾镜气压弹道联合超声碎石术治疗儿童肾结石的安全性和疗效.方法 肾结石患儿44例.男28例,女16例.年龄7～14岁,平均11岁.单侧肾结石39例,双侧肾结石5例.右侧26例、左侧23例,共49侧.44例患儿中有代谢异常者19例(43.2%)、尿路解剖异常15例(34.1%)、尿路感染14例(31.8%).输尿管镜下患侧输尿管逆行留置4～6 F输尿管导管,生理盐水充盈肾盂,B超引导下穿刺目标肾盏建立经皮肾通道,气压弹道联合超声碎石.术后X线摄片和B超检查结石排出情况.结果 44例均一期成功建立皮肾通道.一次取净结石36侧(73.5%),经2次取净结石9侧.结石清除率91.8%(45/49).经2次取石仍有结石残留者经体外冲击波碎石治疗清除结石2例2侧,因出血较多改开放手术取石2侧.手术时间52～132 min,平均79min.2例术中分别输血400和800 ml.无气胸、腹腔脏器损伤等严重并发症发生.37例随访3～18个月,患儿肾功能平稳或较术前改善,肾积水均未加重,未发生远期并发症.结论 经皮肾镜气压弹道联合超声碎石术处理小儿肾结石创伤小、安全高效.     

中药配合经皮肾镜超声气压弹道碎石术治疗肾输尿管结石

目的：探讨中药配合经皮肾镜超声气压弹道碎石术治疗复杂肾输尿管结石的可行性和安全性。方法：对200例复杂肾输尿管结石采用经皮肾镜超声气压弹道碎石术碎石,术后口服八正化石胶囊1~2周。结果：结石1次取净率95%,无肾输尿管穿孔、大出血及尿瘘等并发症。结论：中药配合经皮肾镜超声气压弹道碎石术治疗复杂肾输尿管结石,具有创伤小、操作安全、结石取净率高等优点。但要选择病例适当,熟练手术技巧。     

多通道微造瘘经皮肾输尿管镜钬激光碎石术治疗复杂肾结石

目的 评估多通道微造瘘经皮肾输尿管镜钬激光碎石或气压弹道术碎石术治疗复杂肾结石的安全性和有效性.方法 回顾分析2001年到2009年间利用多通道微造瘘经皮肾输尿管镜钬激光碎石术或气压弹道碎石治疗复杂肾结石58例患者的临床资料.结果 58例患者共62个肾脏接受微造瘘经皮肾输尿管镜碎石术,共建立130条经皮肾通道,最多3个通道,一般仅为2个.58%的通道建立在第11肋间,其余分别位于第12肋下或第10肋间.12例患者术中术后需输血,5例患者出现感染性休克.48例患者经多期手术结石完全清除,清除率达77.4%.结论 多通道经皮肾镜取石术安全、有效,是复杂肾结石的治疗方式之一.     

B超定位经皮肾镜治疗肾及输尿管上段结石940例临床分析

目的：探讨B超定位下经皮肾镜气压弹道联合超声波碎石清石术治疗复杂肾结石及输尿管上段结石的临床治疗结果及远期疗效。方法：选取2005年7月～2008年11月在我科采用B超定位下经皮肾镜气压弹道联合超声波碎石清石术的940例结石患者其临床资料进行回顾性分析。结果：患者双肾结石210例,单侧肾结石730例,其中并发患侧输尿管结石124例;一期碎石成功1060例次,需二期碎石156例次。结论：用B超定位经皮肾镜弹道联合超声碎石清石术治疗肾脏复杂结石及输尿管上段结石具有较高疗效,可被视为治疗该种疾病的“金标准”。     

B超引导经皮肾镜超声气压弹道碎石术治疗复杂性肾结石

目的：评价B超引导下经皮肾镜超声联合气压弹道碎石术治疗复杂性肾结石的临床疗效。方法：对2006年3月-2008年6月，采用B超引导下经皮肾镜超声联合气压弹道碎石术治疗90例96侧复杂性肾结石患者的手术时间、结石清除率、手术并发症等临床资料进行回顾性分析。结果：所有患者均成功建立F24皮肾通道并Ⅰ期碎石，平均手术时间70min，平均结石处理时间为50min。本组未出现气胸、肠道损伤等手术并发症。术后复查KUB平片，83例肾脏结石清除干净，净石率92％；7例肾脏有结石残留，辅助ESWL治愈。随访1～6个月，无严重手术并发症。结论：B超引导下经皮肾镜超声联合气压弹道碎石术处理复杂性肾结石具有高效、安全的特点，值得临床推广应用。     

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.     

泌尿外科：肾脏、输尿管

经皮肾输尿管镜下气压弹道碎石术治疗儿童肾结石；B超引导经皮肾镜气压弹道联合超声碎石术治疗无积水肾结石；医源性损伤致肾盂狭窄闭锁再手术治疗体会；小肾癌54例诊治分析；微创经皮肾取石术（附92例报告）……[编者按]     

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。     

经皮肾镜气压弹道联合超声碎石术治疗肾结石

目的评价经皮肾镜气压弹道联合超声碎石术治疗肾结石的疗效。方法2005年1月~2006年12月,应用经皮肾镜气压弹道联合超声碎石术治疗肾结石132例。在B超引导下建立经皮肾镜碎石通道,气压弹道联合超声碎石将结石清除干净。结果单通道取石122例,二通道取石10例。一期取石127例,二期取石5例。手术时间30~150min,(60±12)min。术后1周结石清除率90.2%(119/132)。5例术后1~4d出血,出血量200~500ml,经输血、抗感染治疗痊愈。其余未见严重并发症。肾造瘘管留置时间4~7d,平均6d。住院时间6~22d,平均15d。98例随访3~20个月,平均13个月,无继发出血、感染,无结石复发。结论经皮肾镜气压弹道联合超声碎石术治疗肾结石创伤小,安全,高效,并发症少。     

B超引导经皮肾镜气压弹道联合超声碎石术治疗无积水肾结石

目的探讨B超引导建立皮肤肾脏通道、经皮肾镜气压弹道联合超声碎石术治疗无积水肾结石的安全性和临床疗效。方法2003年9月—2005年4月,采用B超引导穿刺建立通道、肾镜下气压弹道联合超声碎石术治疗132例无积水肾结石。膀胱镜下患侧输尿管逆行留置5F输尿管导管,生理盐水持续滴注以充盈肾盂。B超引导下穿刺目标肾盏,建立皮肤肾脏通道,肾镜下采用气压弹道联合超声碎石术。对手术时间、手术并发症、结石清除率等临床资料进行分析。结果132例患者均一期成功建立皮肤肾脏通路,129例行一期碎石术,3例行二期碎石术。123例患者一期单通道碎石,9例患者一期两通道碎石。手术时间70~130min,平均(89±11)min,3例患者术中输血400~800ml,无气胸、腹腔脏器损伤等严重并发症发生。术后1周后复查,114例患者排净结石,18例有结石残余,结石清除率86.4%(114/132)。结论B超引导穿刺经皮肾镜碎石术治疗无肾积水的肾结石安全、方便、疗效可靠。     

Pediatric percutaneous nephrolithotomy: assessing impact of technical innovations on safety and efficacy.

OBJECTIVES: To assess the safety and efficacy of percutaneous nephrolithotomy (PCNL) in the pediatric age group and the impact of certain technical modification on the ultimate outcome. PATIENTS AND METHODS: We studied 45 renal units in 40 patients under 15 years of age who underwent PCNL at our institute. The average age was 9.2 years (range 11 months-15 years). There were 5 bilateral, 11 multiple, and 9 staghorn calculi. The average calculus size was 2.04 (0.9-4.5) cm. The PCNL was done with an ultrasound-guided peripheral puncture, a planned staged approach in some cases, and minimal tract dilatation with the use of a pediatric nephroscope and a specially designed slender probe for pneumatic intracorporeal lithotripsy. RESULTS: Complete stone clearance was achieved in 41 of the 45 renal units, giving an overall clearance rate of 91%. Minor pyrexia (<100 degrees F/<2 days) was seen in 10 patients, whereas serious pyrexia was seen in 5. One patient had a prolonged leak from the nephrostomy site, which responded to double-J stenting, and one patient had a pelvic perforation with hyponatremia, which responded to conservative treatment. The average fall in hemoglobin was 1.6 g/dL, but none of the patients required blood transfusion. CONCLUSION: We believe that our alterations in the standard technique of PCNL with the use of pediatric instruments can make it a safe and effective option in the modern management of pediatric urolithiasis.     

经皮肾镜气压弹道联合超声碎石在处理上尿路结石中的临床价值

目的探讨常规24F通道经皮肾镜气压弹道联合超声碎石术（PCNL）在基层医院处理上尿路结石中的临床应用价值。方法回顾分析我院经皮肾镜术中采用瑞士EMSⅢ代气压弹道联合超声碎石清石系统处理的97例104侧上尿路结石患者临床资料,其中,结石位于左肾35例,右肾42例,双侧肾结石7例,输尿管上段结石13例。术中常规建立24F经皮肾工作通道,术后5d复查腹部平片（KUB）了解结石清除情况,观察手术的疗效及并发症。结果 91例患者成功建立24F经皮肾通道并行碎石,6例中转开放手术;PCNLI期净石率81.1%,18侧术后复查存在结石残留,2例行体外冲击波碎石术（ESWL）治疗,余均行Ⅱ期PCNL清石成功。结论 24F通道配合经皮肾镜气压弹道联合超声碎石术具有微创、安全、有效的特点,值得在有条件的基层医院推广应用。     

B超引导下标准通道经皮肾镜气压弹道联合超声碎石治疗复杂性肾结石

目的评价B超引导下建立标准穿刺通道经皮肾镜气压弹道联合超声碎石清石术（PCNL）治疗复杂肾结石的疗效。方法自2006年12月-2009年1月治疗123例128侧肾结石患者,B超引导下建立标准经皮肾穿刺通道,行经皮肾镜下气压弹道联合超声碎石清石术。结果123例患者128侧患肾均Ⅰ期成功建立经皮肾通道,其中3例患者同侧患肾工期建立2个经皮肾通道,1例建立经皮肾通道过程中出血,留置肾造瘘管后改Ⅱ期手术。123例128侧患肾1次取净结石116例,结石清除率90．63％。3例结石残留者1周后再次行PCNL碎石清石术,6例患者有直径小于1cm结石残留,术后行体外冲击波碎石（ESWL）治疗,3例微小结石残留患者予以排石治疗。6例患者出现菌血症,1例患者出现腹膜后血肿,予以对症处理后均治愈出院。所有病例均随访1～24个月,无结石复发。结论B超引导下建立标准穿刺通道行经皮肾镜气压弹道联合超声碎石清石术治疗肾结石具有高效、耗时短、安全等特点,值得临床推广应用。     

经皮肾镜下气压弹道碎石联合超声碎石术治疗复杂性肾结石疗效观察

目的：评价经皮肾镜下气压弹道碎石联合超声碎石术处理复杂性肾结石的疗效。方法：自2003年9月～2004年4月采用经皮肾镜下气压弹道碎石联合超声碎石术Ⅰ期治疗肾结石38例42侧。结果：平均手术时间85min，结石处理时间62min，结石清除率88．1％；5例多发性结石或铸形结石患者经皮通道小角度的肾盏内有直径小于1cm结石残留，辅助施行体外冲击波碎石治疗。随访1～3个月，无严重手术并发症。结论：经皮肾镜下气压弹道碎石联合超声碎石术处理大的复杂性肾结石具有高效、安全的特点，结石清除率高，值得临床推广应用。     

经皮肾镜下气压弹道碎石加超声碎石取石术治疗复杂性肾结石

目的探讨经皮肾镜下气压弹道碎石加超声碎石取石术处理复杂性肾结石的疗效。方法2004年10月至2005年3月,采用经皮肾镜下气压弹道碎石联合超声碎石取石术I期治疗复杂性肾结石28例34侧。结果手术时间平均80 min,结石处理时间60 min,结石清除率91.1%;4例多发性结石或铸形结石患者远处肾盏内有直径小于1 cm残留小结石,辅助施行体外冲击波碎石治疗。所有病例随访1~3个月,均无严重手术并发症。结论经皮肾镜下气压弹道碎石加超声碎石取石术治疗较大的复杂性肾结石安全、高效、容易操作,且结石清除率高,值得临床推广应用。     

输尿管软镜取石术治疗经皮肾镜术残留肾结石12例报告

目的:评估输尿管软镜取石术治疗经皮肾镜取石术(PCNL)残留肾结石的效果。方法:利用输尿管软镜治疗PCNL残留肾结石12例,男8例,女4例;平均年龄42.6岁。左侧5例,右侧3例。KUB测量结石直径为0.7~2.6cm,平均1.4cm。经留置输尿管扩张鞘或沿导丝直接置入输尿管软镜抵达肾盂,寻及结石后以200μm光纤、10 W功率钬激光碎石。观察其手术时间、结石清除率、并发症等疗效指标。结果:本组12例均顺利完成输尿管软镜碎石,手术时间68~116min,平均92min;结石清除率为83.3%(10/12)。1例结石残留患者另作穿刺通道行二期PCNL后结石完全清除;1例术后行ESWL仍有少量结石残留,随访观察。均无严重出血及输尿管穿孔等并发症。结论:输尿管软镜取石术治疗PCNL后残留肾石安全、有效。     

Safety and efficacy of percutaneous nephrolithotomy in the pediatric population

PURPOSE: We reviewed our experience with percutaneous nephrolithotomy (PCNL) in patients in the pediatric age group and compared its efficacy and safety over a 5-year period. PATIENTS AND METHODS: We studied retrospectively and prospectively 31 patients who were treated with PCNL for renal stones larger than 1.5 cm. Variables assessed were stone bulk, size, location, and type. Metabolic and anatomic factors were also assessed. PCNL punctures and number of tracts were recorded. Clearance with PCNL and ancillary procedures was recorded. RESULTS: There were 31 renal units. Mean age of the patients was 9.6 years (range 1.5-15 years). Fifteen (48.4%) patients had single calculi; eight (25.8%) patients had staghorn calculi. Lower-pole access was the preferred route of entry, and upper-pole access was used only when necessary. We used a 22F nephroscope for the procedure. We dilated the tract to 30F in the majority of patients, but limited dilation to 24F when appropriate. If needed, we used a ureteroscope. Complete clearance was achieved in 83.9% of patients after PCNL and in 90.32% of patients after dual therapy (PCNL + shockwave lithotripsy). Average hemoglobin drop was less than 1 g/dl. Factors responsible were the size of the tract (larger than 24F) and the number of tracts. Six patients were treated for an anatomic abnormality. A metabolic abnormality was diagnosed in three patients. CONCLUSION: PCNL is effective in children, with a clearance rate of 83% and, with dual therapy, more than 90%. We recommend that tract dilation be restricted to 24F or smaller whenever possible. Approximately 40% of patients had either an anatomic or metabolic abnormality.     

Percutaneous nephrolithotomy in the management of pediatric renal calculi

BACKGROUND AND PURPOSES: In the era of extracorporeal shockwave lithotripsy (SWL), there are still some patients who will require percutaneous nephrolithotomy (PCNL). Our experience with this procedure is reviewed and discussed. PATIENTS AND METHODS: Fifty five patients with a mean age of 7.9 years (10 months-14 years) underwent 67 PCNL procedures on 62 renal units between September 1997 and April 2001. Of the patients, 13 had previous open renal surgery, 4 had a solitary kidney, 4 were SWL failures, 2 had osteogenesis imperfecta, one had anuria secondary to bilateral calculi, 2 had poorly functioning kidneys, and 1 had cystinuria (complete staghorn calculus). One disabled patient with neurologic disorders who had multiple stones underwent PCNL in order to decrease the stone burden and to improve the kidney function. Operations were performed under the guidance of monoplane fluoroscopy. Pneumatic or ultrasonic lithotripsy and forceps extraction were used with a rigid nephroscope or ureteroscope (as an alternative instrument in small-caliber tracts). RESULTS: Excluding the patient with neurologic disorders, 53 of the renal units (86.9%) were stone free at the time of discharge, and the success rate was 96.7%, with six patients having insignificant residual fragments after the procedure. In one patient, open surgery was required, and the other patient was sent for SWL treatment. There was no contiguous organ injury, but in 16 procedures (23.9%), intraoperative hemorrhage was seen, and blood transfusions were required. CONCLUSION: Pediatric urolithiasis is usually a result of metabolic abnormalities and urinary tract infection, and there is always a risk of recurrence that may necessitate multiple additional intervention. Therefore, PCNL must be considered in selected cases by urologists who are experienced in adult percutaneous procedures.     

微创经皮肾取石术治疗独立肾结石

目的：探讨微创经皮肾取石术治疗孤立肾结石的临床疗效与手术技巧。方法：利用微创经皮肾取石术治疗孤立肾结石18例，14例患者行一期微创经皮肾取石．4例行经皮肾穿刺造瘘术，5～7天后行二期取石术。结果：结石清除15例（83．3％）。在结石残留的3例患者中，1例残留结石下移至输尿管下段，用输尿管镜将结行取出；余2例结石残留。肾内，未作进一步处理，本组患者术后肾功能基本恢复正常或好转。结论：微创经皮肾取石术治疗独立肾结石是一种安全、有效的方法。     

经皮肾镜治疗嵌顿性输尿管上段结石（附81例报告）

目的评价经皮肾镜下气压弹道联合超声碎石术处理嵌顿的输尿管上段结石的疗效。方法回顾性分析2005年6月至2008年4月采用经皮肾镜下气压弹道联合超声碎石术治疗嵌顿的输尿管上段结石81例临床资料。结果81例患者均成功建立皮肾通道，均一期单通道碎石，手术时间35—120min，结石完全清除率98．7％（80／81）。1例患者结石残留，经ESWL治疗；11例术后出现发热，给予适当的抗生素及支持性治疗；4例患者因术中出血输浓缩红细胞2U；均获治愈。随访1—9个月，无严重手术并发症。结论经皮肾镜下气压弹道联合超声碎石术用于处理嵌顿的输尿管上段结石是安全有效的方案。