徒手超声引导下经皮肾输尿管镜碎石术治疗肾结石的探讨

目的 探讨徒手超声引导及输尿管镜替代肾镜进行经皮肾镜手术的可行性.方法 采用徒手超声引导下进行术中定位、穿刺,输尿管镜替代肾镜行经皮肾镜碎石术治疗肾结石35例,对其临床资料进行回顾性分析.结果 35例均成功建立皮肾通道并一期手术,其中单通道清除结石34例,双通道1例.2例行二期碎石清石术.总手术时间50～130min,建立通道时间15～25 min,一期手术结石清除率为94.28％ (33/35),无大出血、感染性休克等严重并发症.结论 徒手B超引导下输尿管镜替代肾镜的经皮肾镜碎石术治疗肾结石安全、有效并且是可行的.

Investigation on Free-hand Ultrasound-guided Percutaneous Nephrolithotomy or Nephrolithotripsy with Ureteroscope for Kidney Stones

OBJECTIVE To investigate the feasibility of performing free-hand ultrasound-guided percutaneous nephrolithotomy or nephrolithotripsy with ureteroscope instead of nephroscope. METHODS Thirty-five consecutive patients with kidney stones were retrospectively studied, all of which underwent percutaneous nephrolithotomy or nephrolithotripsy using intraoperative free- hand ultrasound-guided localization, nephrostomy and lithotripsy with ureteroscope. RESULTS We established successfully the working channel and performed first-stage surgery in all 35 cases. Thirty-four cases were effectively cleared of kidney stones us- ing singe channel while 1 using dual channels. Two underwent second-stage stone clearance. It took about 15-25 min to estab- lish percutaneous working channel. Total operating time ranged 50-130 min. The rate of stone clearance was 94.28% (33/35). There were no severe complications such as massive blood loss, septic shock. CONCLUSION Free-hand ultrasound-guided percutaneous nephrolithotomy or nephrolithotripsy with ureteroscope for kidney stones is safe , effective and feasible.