超声引导经皮肾镜气压弹道联合超声碎石清石术治疗无积水肾结石

目的探讨超声引导经皮肾镜气压弹道联合超声碎石清石术治疗无积水肾结石的安全性和临床疗效。方法2005年7月至2008年6月，采用超声引导穿刺建立皮肤肾脏通道、经皮肾镜下气压弹道联合超声碎石清石术治疗97例无积水肾结石。膀胱镜下患侧输尿管逆行留置5F输尿管导管，0．9％NaCl溶液持续滴注以充盈肾盂。对手术时间、手术并发症、结石清除率等临床资料进行分析。结果97例患者均一期成功建立皮肤肾脏通道，95例行一期碎石术，2例行二期碎石术。92例患者一期单通道碎石，5例患者一期两通道碎石。手术时间70—180min，平均（96±23）min，术中出血量20～500ml，平均60ml，4例患者术中输血400ml。术后低、中度发热者24例，高热者3例，经选用合适的抗生素治疗，术后5d内体温恢复正常。无气胸、腹腔脏器损伤等严重并发症发生。术后1周复查，结石清除率80．4％（78／97）。结论超声引导经皮肾镜气压弹道联合超声碎石清石术治疗无积水肾结石安全、方便，疗效可靠。

Percutaneous nephrolithotripsy with pneumatic and ultrasonic power under ultrasound guidance for treatment of kidney calculi in non-uronephrosis

Objective To evaluate the efficacy and safety of management of kidney calculi in non-uronephrosis by percutaneous nephrolithotripsy （PCNL） under ultrasound guidance. Methods From July 2005 to June 2008, 97 cases of kidney calculi in non-uronephrosis were performed by percutaneous nephrolithotripsy. A tube was first inserted into the pelvis through cystoscope, and saline was instilled to dilate collecting system. Antegrade ptereutaneous access was obtained under ultrasound guidance. A combination of pneumatic and ultrasonic lithotrite was used to disintegrate and remove stone under direct vision. Clinical data including operation time, complications and stone free rate were analyzed retrospectively. Results The perutaneous renal access was successfully established under ultrasound guidance in all patients, immediate phase Ⅰ lithotripsy was performed in 95 cases and delayed phase Ⅱ lithotripsy in 2 cases. Operation time was 70-180 min, average time was （96 ± 23） min. The average blood loss was 60 ml （20-500 ml）, 4 cases had transfusion during the PCNL and average 400 ml. Minor pyrexia （ 〈 39℃ ） was seen in 24 cases, whereas serious pyrexia was noted in 3 eases. Conservatively administered with appropriate antibiotics, the fever disapeared in 27 cases within 5 days postoperatively. Severe complications did not occur during nephrolithotripsy. Stones were cleared completely in 78 out of 97 cases （80.4%）during immediate phase Ⅰ lithotripsy, residual stone fragment was found in 19 cases. Conclusion The management of kidney calculi in non-uronephrosis by PCNL appears to be efficacious and safe under ultrasound guidance.