经皮肾镜超声弹道碎石术治疗复杂性肾结石

目的：探讨经皮肾镜超声弹道碎石术治疗复杂性肾结石的疗效。方法：采用经皮肾镜联合EMS Ⅲ代超声弹道碎石清石系统治疗48例复杂性肾结石患者，完全性鹿角状结石12例，部分鹿角状结石30例，多发性结石6例。结石直径2．0～6．5cm，平均2．8cm。结果：48例患者中，43例Ⅰ期取净结石；5例完全性鹿角状结石者术后2个月仍有结石残留，结石直径均小于1．0cm，辅助施行ESWL后排净。结石粉碎率100％，结石清除率89．6％（43／48）。手术时间50～120min，平均70min，平均出血量50ml。无严重并发症发生。术后随访3～6个月，肾功能均有不同程度改善。结论：经皮肾镜下使用EMSⅢ代碎石清石系统治疗复杂性肾结石，具有高效、可靠、安全、损伤小、出血少及恢复快等优点，可以作为目前治疗复杂性肾结石的首选方法。

Treatment of complicated renal calculi under percutaneous nephrolithotomy with ultrasonic and pneumatic lithotriptor

Objective:To evaluate the clinical efficacy of percutaneous nephrolithotomy with ultrasonic and pneumatic lithotriptor for the complicated renal calculi.Methods:The present study includes 48 cases of patients with complicated renal calculi who received percutaneous nephrolithotomy that had been preformed with ultrasonic and pneumatic lithotriptor (EMS III,Switzerland).Of these 48 cases,complete staghorn calculi were noted in 12 cases, partial staghorn calculi in 30 cases, multiple calculi in 6 cases. The mean diameter of calculi was 2.8 cm (range from 2.0 to 6.5 cm).Results:The stones were cleared out in 43 out of 48 cases.Other 5 cases of complete staghorn calculi were treated by ESWL due to residual stones(diameter<1.0 cm) after two months of operation,then the residual stones were discharged completely.All stones were fragmented and the stone clearance rate was 89.6% (43/48). The operative duration was 50~120 minutes,averaged 70 minutes.No obvious complications were observed. The average intraoperative blood loss was 50 ml.The renal function had demonstrated some extent improvement during the follow up period of 3~6 months.Conclusions:Percutaneous nephrolithotomy with ultrasonic and pneumatic lithotriptor (EMS 3) for complicated renal calculi has the advantages of high efficacy,reliability,safety,mini invasion,less haemorrhage and rapid recovery.It should be the first choice for complicated renal calculi at present.