彩色多普勒超声引导无血管化穿刺行经皮肾镜超声弹道碎石术治疗肾结石

目的：通过回顾性分析临床资料,探讨彩色多普勒超声引导下无血管化标准通道经皮肾镜气压弹道联合超声碎石清石术治疗肾结石的疗效。方法：回顾性分析2005年2月-2011年12月笔者所在医院采用彩色多普勒超声引导标准通道经皮肾镜EMS气压弹道联合超声碎石清石系统治疗447例470侧肾结石的资料。在彩色多普勒超声定位下,避开血管建立Fr22的皮肾通道,行标准通道经皮肾镜气压弹道联合超声碎石清石术。结果：手术时间30~180min,平均75min。术中失血量20~200ml,平均50ml。447例均一期穿刺成功并同时碎石。术后复查腹部平片,53例显示残余结石〉4mm,行二期碎石,其中16例需行三期碎石,一期净石率约88.1%。2例因术中急性出血,影响视野,留置造瘘管1周后行二期碎石,术后延迟性大出血7例,6例经保守治疗,血尿消失,1例行高选择性肾动脉栓塞,无死亡病例。结论：彩色多普勒超声引导下无血管化标准肾镜经皮肾穿刺取石术治疗肾结石,具有创伤小、出血少及并发症少的优点,是治疗肾结石的较好方法。

The Effect of Percutaneous Nephrolithotripsy in Treatment of Renal Calculi in Avascularity Puncture under Color Doppler Ultrasound Guidance

Objective：To evaluate the efficacy of percutaneous nephrolithotripsy（PCNL） under color Doppler ultrasound guidance in treatment of renal calculi by retrospective analysis of clinical data.Methods：From Feburary 2005 to September 2009,a total of 447 patients （470 kidneys） with renal calculi were underwent primary PCNL by guidance of color doppler ultrasound.The working channel was dilated until an F22 access was positioned.Results：The average operative time was 75 min （range 30-180 min）. The average blood loss was 50 ml （range 20-200 ml）.Residual calculi （4 mm） was found in 53 cases by postoperative kidney-ureter-bladder X-ray （KUB） and they received a second PCNL;16 cases received a third PCNL.The stone-free rate for renal calculi was 88.1% after the pray procedure.Two cases had to stop operating because of severe intraoperative hemorrhage.7 cases had severe hemorrhage postoperatively and 6 cases were cured with conservative therapy;Only one case were cured with super selective angiographic embolization.Conclusion：PCNL under color doppler ultrasound guidance is effective and safe,which is great worthy of clinical application.