超声引导经皮肾镜气压弹道联合超声碎石清石术治疗肾结石及输尿管上段结石

摘要

Objective To evaluate the clinical efficacy and safety of the percutaneous nephrolithotomy lithotomy(PCNL)and fourth generations of EMS treatment for renal calculus and upper ureteral calculus.Methods 206 cases of renal calculus and upper ureteral calculus, 6 cases had undergone nephrolithotomy,3 cases had undergone ureterolithotomy.The stone was 1.7～6.3cm.PCNL guided by B-ultrasonography and with fourth generations of EMS treatment for renal calculus and upper ureteral calculus.Retrospectively analyzed the time of the operation ,the clearance of the stone ,the complication.Results Homogenization of 206 cases in this group to establish percutaneous renal access ,the total rate of clear of stone was 89.4％ ,the rate of remove the pyelic obstruction was 100％.The patients were discharged from hospital after operationin were 8.1 days.The mean operation time was 74 minutes.The rate of remove single renal calculus was 92％.After operation,urinary system X-ray showed 21 cases with residual stones, and 8 cases did stage Ⅱ PCNL from previous tunnel, residual stones in the ureter in 4 cases fall into the ureter holmium laser lithotripsy,5 cases was combined with external shock wave lithotripsy(ESWL) ,residual stones in 4 cases were discharged after one month.27 cases had short fever after operation, the temperature became normal after symptomatic treatment, they were followed up for 1 ～ 6 months, during the period, no hemorrhage, no infection, no fluidify.5 cases, renal calculus with liquor puris, were establish the access for drainage at the first stage ,did stage Ⅱ PCNL after control the infection for 15 days.Delayed massive hemorrhage in the kidney was detected in 3 cases after the surgery, they were then cured by symptomatic treatment, two cases in which blood transfusion 400 ml,no shock.Conclusion PCNL combined with fourth generations of EMS can increase the rate of gravel,stone clearance rate, shorten the operation time,decreased the hemorrhage and fever after surgery, is a safe , mini-invasiv and effective method for the treatment of renal calculus and upper ureteral calculus.%目的 探讨与评价经皮肾镜应用第四代EMS超声气压弹道碎石清石系统治疗肾结石及输尿管上段结石的安全性与疗效.方法 肾结石及输尿管上段结石206例,6例曾行肾切开取石,3例曾行输尿管切开取石术.术前KUB测量结石最大1.7～6.3cm.在B超引导下穿刺并扩张建立经皮肾镜操作通道,采用EMS第四代气压弹道联合超声碎石清石系统治疗肾结石,对其手术时间、结石清除率、手术并发症等资料进行分析.结果 本组206例均一期建立经皮肾通道,手术总的结石取尽率89.4%,肾盂梗阻解除率100%.术后平均住院时间8.1d.平均手术时间74min.单发肾结石取尽率92%.术后泌尿系X线片检查显示21例残石,8例肾残石经原通道二期取石,4例残石掉入输尿管行输尿管钬激光碎石术,5例术后1个月体外冲击波碎石,4例术后1个月复查结石自行排出.27例术后短期发热,经予以对症治疗后体温恢复正常,随访1～6个月,无出血、感染、肾周积液.5例肾结石合并肾积脓患者先经皮肾穿刺后置引流管,控制感染半月后行二期碎石.3例术后出血较重,均予以保守、对症治疗出血控制,其中两例输血400ml,无中毒性休克发生.结论 经皮肾镜应用第四代EMS超声气压弹道碎石清石术治疗肾结石,可提高碎石、清石率,缩短手术时间,降低术后出血,减少术后发热,具有高效、微创、安全的特点,值得-临床推广应用.