经皮肾镜取石术联合套石网篮治疗 ESWL 排空障碍的输尿管上段结石合并肾盏结石

摘要

目的：探讨经皮肾镜取石术（ percutaneous nephrolithotomy ， PCNL ）联合套石网篮治疗体外震波碎石（ extracorporeal shock wave lithotripsy ，ESWL）排空障碍的肾盏及输尿管上段结石的临床疗效。方法2009年4月～2012年8月采用PCNL联合套石网篮治疗ESWL排空障碍的输尿管上段结石合并肾盏结石78例。 B超定位，58例肾盏结石长径＜1 cm或分布于单组肾盏，采用微通道经皮肾镜下气压弹道碎石；20例肾盏结石长径＞1 cm或分布于多组肾盏采用新型经皮肾镜标准通道下气压弹道或超声联合气压弹道碎石。结果78例手术均获成功，手术时间52～98 min，平均61 min。71例一期取净结石，结石取净率91．0％（71/78）；2例二期碎石后取净；3例辅助行ESWL治疗；2例因残留结石较小药物排石排出。住院5～12 d，平均7．2 d。无胸膜及其他重要脏器损伤，无大出血等严重并发症。78例随访3个月，未见结石残留。结论PCNL术中联合套石网篮可减少皮肾穿刺通道数，避免大出血及集合系统狭窄风险，是处理ESWL排空障碍的肾盏及输尿管上段结石恰当的选择。%Objective To explore the efficacy of percutaneous nephrolithotomy ( PCNL ) for calyceal and upper ureteral calculi following failure of extracorporeal shock wave lithotripsy (ESWL). Methods A total of 78 patients with calyceal and upper ureteral calculi underwent PCNL with dormia basket from April 2009 to August 2012 after treatment failure with ESWL .Under the guidance of ultrasonography , we performed mini-tract percutaneous pneumatic lithotripsy on 58 cases of calyceal calculi with a diameter of less than 1 cm or located in a single set of calyces; we performed standard-tract percutaneous pneumatic lithotripsy or combined pneumatic and ultrasound lithotripsy on 20 cases of calyceal calculi with a diameter of more than 1 cm or located in multiple sets of calyces. Results All 78 operations were performed successfully .The operative time was 52 -98 min ( average, 61 min).The stones in 71 cases were removed completely with the stone clearance rate of 91.0%(71/78);stones were cleared in 2 cases during the second surgery;3 cases received ESWL; 2 cases underwent drug therapy and stones were discharged due to their small size .The hospital stay was 5-12 d (average, 7.2 d).No injury of pleura or other vital organs occurred .No massive haemorrhage or other severe complications occurred .During the follow-up of 3 months, no residual stones were found in all the 78 cases. Conclusions PCNL with dormia basket is safe and effective for the treatment of calyceal and upper ureteral calculi following failure of ESWL .It can decrease percutaneous renal channels , reduce the risk of massive bleeding and stenosis of renal collecting system .