彩超引导下经皮肾镜碎石取石术治疗上尿路结石285例临床分析张杰李春茂李大平杨烁杨天夏茂楠游云超.docVIP

彩超引导下经皮肾镜碎石 取石术治疗上尿路结石285例临床分析 张杰1 李春茂1 李大平1 杨烁1 杨天1 夏茂楠1 游云超1 [摘要]目的：探讨彩超引导下经皮肾镜碎石清石术治疗上尿路结石的安全性及有效性。方法：回顾性分析2008年4月至2012年9月采用彩超引导下建立经皮肾道行经皮肾镜碎石清石术治疗上尿路结石285例患者的临床资料，总结分析手术方法、手术时间、治疗效果及并发症等情况。结果：282例患者均一次穿刺成功，建立皮肾通道，3例患者因穿刺扩张后，通道丢失，再次重新穿刺扩张。15例患者行双通道穿刺扩张，285例患者中一期清石77.2%（220/285），二期清石25例，23例残留结石0.5-1cm行ESWL治疗，17例残留结石≤0.4cm行体位排石等保守治疗。平均手术时间101±25min；平均出血量108±58ml。肾造瘘管留置时间平均7.3天，术后平均住院时间8天。输血8例，1例大出血行高选择性肾动脉栓塞术；2例术后发现气胸行胸腔闭式引流后好转；1例术后出现反复感染行肾切除术，8例因穿刺引流液为脓性，行二期清石后治愈。18例为双侧上尿路结石，一期手术10例，分期手术8例。术后发热45例，5例高热。结论：彩超引导下经皮肾镜碎石取石术治疗上尿路清石，创伤小、恢复快、安全高效、并发症少、疗效明显。 [关键词]彩超引导；经皮肾镜碎石取石术；上尿路结石 Clinical analysis of 285 clinical case of percutaneous nephroscope set Lithotripsy to cure lithangiuria under the guide of Color doppler ultrasound Jie ZHANG1 Chunmao LI1 Daping LI1 Shuo YANG1 Tian YANG1 Maonan XIA1 Yunchao YOU1 (1Department of Urology , Second Peoples Hospital of Dazhou , Dazhou, Sichuan, 635002，China) [Abstract]Objective: discuss the safety and effectiveness of percutaneous nephroscope set Lithotripsy to cure lithangiuria under the guide of Color doppler ultrasound. Method: retrospective analyze, from 4/2008 to 9/2012, 285 clinical data of percutaneous nephroscope set Lithotripsy to cure lithangiuria under the guide of Color doppler ultrasound, summarize and analyze operation method, time, therapeutic effect, complication, etc.Result: all of the patients of 282 clinical data were successfully punctured once at one time and established skin kidney channel. 3 patients loss the channels after the puncture expansion, so punctured again. 15 patients got the dual channel puncture expansion. 77.2% of the 285 patients have cleared calculus at the first phrase, and 25 patients cleared at the second phrase. The left 23 patients with residual calculus 0.5-1cm got ESWL cure, 17 patients with residual calculus less or equal to 0.4 cm got conservative treatment of position removing calculus. The average time of operation is 101±25min, the average amount of bleeding is 10