经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石150例报告

目的探讨经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石的疗效。方法全麻下经膀胱镜先向患侧逆行插入输尿管导管,俯卧位,在B超或X线引导下,向目标肾盏穿刺,建立皮肾通道,肾镜下用气压弹道联合超声腔内碎石机碎石取石。结果单通道取石137例,双通道取石11例,三通道取石2例;一次取石119例,二次取石27例,三次取石4例。手术时间（88±34）min。1例术后当晚发生感染性休克,经抗休克治疗后缓解;2例术后2周继发出血,保守治疗后缓解。术后3个月结石取净率为84.7%（127/150）;23例残余结石中,术后10例行ESWL治疗,其中7例结石排净,余13例口服排石药,术后6个月随访结石排净率为89.3%（134/150）。结论经皮肾镜气压弹道联合超声碎石取石术治疗复杂性肾结石效率高,安全有效,损伤小,可以解决开放手术难以处理的复杂性肾结石。

Percutaneous Nephrolithotomy Combined with Pneumatic and Ultrasonic Lithotripsy for Complex Renal Calculi: Report of 150 Cases

Objective To evaluate the clinical efficacy of percutaneous nephrolithotomy （PNL） in combination with pneumatic and ultrasonic lithotripsy in the treatment of complex renal calculi. Methods Under general anesthesia, an ureteral stent was placed into the patient by cystoscopy. With the prone position, percutaneous access was established by inserting an access needle into the intended calix under the guidance of ultrasonography or fluoroscopy. Afterwards, combined pneumatic and ultrasonic probes were used by nephroscopy for lithotripsy. Results A single tract was used in 137 patients, while two or three tracts were created in the other patients （11 and 2 respectively）. One-step procedure to remove the stones was achieved in 119 patients, while a second intervention was performed in 27, and three procedures was carried out in 4. The mean time of the operations were （88 ± 34） min. After the operation, one patient developed infectious shock, and then was cured by anti-shock therapy; two patients showed secondary hemorrhage in two weeks postoperation, and was cured by conservative therapy. In this series, the rate of stone clearance was 84.7% （127/150） ; 23 cases had residual stones, 10 of them received ESWL （the stone was removed completely in 7 of the 10 cases）, and the other 13 were treated by oral medicines. Six months after the operation, follow-up examination showed a stone-free rate of 89.3% （134/150）. Conclusion Combination of ultrasonic and pneumatic intracorporeal lithotripsy is effective and safe for complex renal calculi, which is intractable by open surgery.