超声引导经皮肾镜气压弹道联合超声碎石清石术在治疗复杂性肾结石中的应用

目的探讨超声定位引导经皮肾镜气压弹道联合超声碎石清石术治疗复杂肾结石的疗效及其安全性。方法 2009年5月至2011年2月,采用超声引导经皮肾镜气压弹道联合超声碎石清石术治疗56例复杂肾结石患者,均在B超引导下穿刺并扩张建立F24皮肾通道,应用瑞士EMS三代气压弹道联合超声碎石清石系统在肾镜下进行碎石清石,术中B超检查示有残留结石的患者,则在B超引导下进入结石位置肾盏进行碎石清石。结果手术的时间为40～160 min,平均手术时间为(68.2士4.7)min;术中失血量为20～800 ml,平均失血量为(70.3±3.5)ml。45例患者一期经皮肾镜碎石(PCNL)取净所有结石,一期净石率为80.3%;11例患者接受二期碎石,总净石率94.6%(53/56)。结论超声引导下经皮肾镜气压弹道联合超声碎石清石术是治疗复杂肾结石的有效安全的方法,术中B超检查有助于检出和清除残留结石。

The combined application of pneumatic and ultrasonic lithoatripsy in ultrasound-guided percutaneous nephrolithotomy for the treatment of complex kidney stone

Objective To evaluate the efficacy and safety of the combination of pneumatic and ultrasonic lithotripsy in ultrasound - guided percutaneous nephrolithotripsy （PCNL） for the treatment of complex kidney stone. Methods From May 2009 to February 2011,56 patients with complex kidney stone diseases underwent combined pneumatic and ultrasonic lithoatripsy. The percutaneous renal access for PCNL was established under the guidance of B ultrasound. The stones were fragmented and removed under nephroscope by Swiss EMS ultrasound and pneumatic lithotrip- sy system. Results The average operative time was 68.2 ± 4.7 min （ range 40 - 160 min）. The average blood loss was 70.3 ± 3.5 ml （ range 20 ± 800 ml）. 45 cases （80.3%） were stone -free after the first PCNL. 11 patients received a second PCNL. The total stone clearance rate was 94.6% （53/56）. Conclusion Ultrasound - guided combined pneumatic and ultrasonic lithotripsy is an effective and safe method of PCNL for the treatment of complex kidney stone. Intraoperative ultrasonography may facilitate the detection and extraction of residual stones.