超声联合气压弹道碎石术治疗复杂性肾结石(附78例报道)

目的:探讨经皮肾镜下超声联合气压弹道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F22经皮肾镜操作通道,在F20.8肾镜下采用瑞士第三代EMS超声气压弹道碎石机,争取一期粉碎结石并主动吸出体外。结果:78例83侧肾结石,单侧结石清除时间43~156min,平均89min。结石粉碎率100%,结石取净率85.6%(71/83)。术后随访1~9个月,平均5.6个月,均无严重并发症如出血及感染,亦无结石复发。结论:经皮肾镜超声联合气压弹道碎石术可以明显地提高复杂性肾结石取石的效率,降低结石的残余率,具有高效、安全、微创的特点,有较好的推广应用价值。

Combination of pneumatic and ultrasoud lithotripsy for the treatment of complicated renal calculi(Report of 78 cases)

Objective:To investigate the techniques and effects of percutaneous nephroscopic pneumatic and ultrasoud lithotripsy for complicated renal calculi.Methods:With the help of B type ultrasonography, a F22 percutaneous working channel for nephroscopy was established. Renal stones were tried to fragmente and extracte one-stage under a F20.8 nephroscope by using the LithoClastMaster ( EMS, Switzerland).Results:Of 83 lateral renal calculi (78 patients),the time for unilateral complete stone clearance was 43-156 min (mean, 89min). All the stones were successfully fragmented and the stone clearance rate was 85.6% (71 /83). Seventy three lateral renal calculi were successfully performed one-stage, and one-stage stone clearance rate was 87.9%.The renal fistulization tubes were removed 5-9 days after operation and the urethral catheter was removed 3 days afterwards. The double-J tube was removed about 1 month after operation. The postoperative hospital stay was 5-16 days (mean, 8.4 days). Ten cases of patients were found having residual stones. Seven was in the renal or upper ureter, which were less than 1cm in diameter and managed later by extracorporeal shock wave lithotripsy ( ESWL) at 1-2 weeks after operation for 1-2 times. Three was in renal calix , of which two cases had performed two-stage PCNL and one (the giant renal calculi about 8cm in diameter), was perfomed two-stage PCNL three times and postoperative ESWL. Of the 78 cases, no severe complication noticed, such as hemorrhage, infection or recurrence was observed during the postoperative followup for 1-9 months (mean, 5.6 months).Conclusions:Percutaneous nephroscopic pneumatic and ultrasoud lithotripsy can obviously improve the efficiency of calculus removed for complicated renal calculi, which is minitrauma, effective, and safe, and has a perfect prospect for clinical application.