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。

Clinical evaluation of pneumatic and ultrasonic lithotripsy during 24 F-channel percutaneous nephrolithotomy in the treatment of renal and ureteral calculi

Objective To explore the clinical value of percutaneous pneumatic and ultrasonic nephrolithotomy for upper urinary calculi in primary hospital. Methods The clinical data of 97 patients （104 sides） who underwent percutaneous pneumatic and ultrasonic nephrolithotomy by EMS Ⅲ of Switzerland were analyzed retrospectively. Thirty-five patients got stones in the left kidney, 42 patients in the right kidney, 7 patients in bilateral kidney, 13 patients in the upper ureter. 24-F percutaneous renal access was established conventionally. They were rechecked by KUB for the stone clearance and the efficacy and complications of the surgery. Results 24-F percutaneous renal access was established successfully in 91 patients, the other 6 patients were converted to open surgery. The stone free rate of the first stage was 81.1%. Residual stones were found in 18 sides. Two patients underwent extracorporeal shock wave lithotripsy （ESWL ）.The stone clearance rate was 100% after the second PCNL. Conclusions Ultrasonic, pneumatic and combination intracorporeal lithotripsy for percutaneous nephrolithotomy in 24 F-channel is minimally invasive, safe and effica-cious and can be applied in the primary hospital.