两种方法引导建立微通道经皮肾镜治疗无积水肾下盏结石的比较研究

目的比较B超联合x线和单纯x线引导建立微通道经皮肾镜治疗无积水肾下盏结石的结果．方法B超联合x线引导组61例（A组）；男性40例，女性21例，平均年龄44（22～56）岁．结石位于左侧27例，右侧24例，双侧10例，结石平均大小1．7（1．2～2．6）cm．A组由B超引导穿刺至结石，x线引导下置入导线，单纯x线引导组57例（B组），两组通道均扩张通道至18F，置入16F工作鞘，F8／9．8输尿管镜，气压弹道碎石或钬激光碎石取石．比较两组一次性穿刺成功率、穿刺时间、接受x线照射时间、以及治疗效果．结果A组和B组平均穿刺时间、1次穿刺成功率和射线照射时间分别为5．4（范围2～12）min和6．2（范围2～16）min（P〉0．05）；1次穿刺成功A组57例（93．4％）和B组48例（84．2％）（P〈0．05），射线照射时间A、B组分别为2．4（1．5～5．3）min和4．9（3～11）min（P〈0．05）．A组1次性取净结石57例（93．4％），B组52例（91．2％），P〉0．05，两组均无并发症发生．结论经皮肾镜治疗无积水肾下盏结石时，联合使用B超和x线引导可提高建立通道的成功率，明显降低医生和患者接受射线照射的量．

Combination of B Ultrasound and X-ray Guides to Build Mini-tract of Lower Calyces Stone without Hydrops

Objective To compare the effects of combining B ultrasound and X-ray or single X-ray in guiding to build mini-tract of renal lower calyces stone without hydrops. Methods The work tract of 6l cases （1 Group） with renal lower calyces stone without hydrops, male 40 cases, female 21 cases, mean age 44 （22 - 45） were built with combining B ultrasound and X-ray. Among of them left stone and right stone and bilateral stones were 25, 26 and 10 cases, respectively, the mean size of stone was 1.7 （1.2 - 2.6） cm. The work tract of another 57 cases （2 Group） , male 39 cases, female 18 cases, mean age 44 （22 - 66） , 28 cases with right stones and 29 cases with left stones, were built by X-ray guide alone. The mea size of stone was 1.8 （1.2 - 2.8） era. The tract of 2 group were dilated to 18F, 16F work sheath was inserted. The stone was removed by 8/9.8 F ureteroscope with hulmium laser or Ballistic lithotrity. Results The time of puncture, the success rate of puncture, the time of accepting X-ray, was 5.4 （2 - 12） and 6.2 （2 - 16） mintue, P 〉0.05,respectively. 57 cases （93.4%） of 1 group and 48 cases （84.2%） got success in one puncture, P 〉 0.05. The rate of free stone in 1 group and 2 group was 93.4% and 91.2%, P〉 0.05, No complications of patients in 2 group were found. Conclusions Combination of B ultrasound and X-ray guide to build the tract is feasible and the success rate of the puncture may be elevated when lower calyces stone without hydrops is need to be treated by mini-percutaneous nephroscope.