经皮肾镜超声碎石清石术治疗复杂性肾结石56例.docxVIP

【摘要】? 目的 探讨经皮肾镜气压弹道超声碎石术 治疗复杂性肾结石的有效性及安全性。方法 对接受经皮肾镜气压弹道超声碎石术的56例复杂性肾结石患者的资料进行回顾性分析,其中单侧结石 43例,双侧结石13 例， 鹿角形结石 48例，合并脓肾18例，合并肾积水11例，结石长径5～8 cm。采用B 超定位建立经皮肾镜操作通道,EMS 第3代气压弹道超声碎石机粉碎并清除结石。结果 手术时间30～120 min,中位时间50 min。结石一次取净率80.3%, 术后残留结石配合体外冲击波碎石术(ESWL)碎石,结石完全排净。结论 微创经皮肾镜气压弹道超声碎石术治疗复杂性肾结石具有创伤小、痛苦小、结石清除率高、安全性高等特点,值得临床推广。 【关键词】? 肾结石;经皮肾镜;超声;碎石术 　　Abstract： Objective To evaluate the efficiency and safety of percutaneous pneumatic nephrolithotomy combined with ultrasound lithotripsy in the treatment of complicated renal calculi. Methods 56 patients with complicated renal calculi were investigated retrospectively, including 43 cases with unilateral calculi, 13 cases with bilateral calculi, 48 cases with staghorn calculi,18 cases with pyonephrosis. The longitudinal size of calculi was 5-8 cm.Working channel for percutaneous nephroscopy was established under the guidance of B ultrasonography. Renal stones were fragmented and extracted with the EMS 3.Results The mean operation time was 50 minutes(30-120 minutes). The clearance rate of stone in one session was 80.3%, residual stones were treated by EWSL,the stones were discharged completely. Conclusion The percutaneous pneumatic nephrolithotomy combined with ultrasound lithotripsy for complicated renal calculi is characterized by high efficiency, safety and minimal invasion. 　　Key words: renal calculus; percutaneous nephroscopy; ultrasound; lithotripsy 　　EMS第3代气压弹道超声碎石系统,结合了气压弹道和超声两种碎石方法,并采用独特的结石吸附装置,在碎石的同时可清除结石。我院2006 年11月—2008年12月采用该方法治疗复杂性肾结石56例,取得了良好的效果。现报告如下。 　　1 资料和方法 　　1.1 临床资料 本组56例, 男38例, 女18例,年龄31～79岁,中位年龄49岁。鹿角形结石48例; 合并脓肾18例，合并肾积水11例(肾积水15～50 mm),合并肾功能不全12例。结石长径5～8 cm,单侧结石43例，双侧肾结石13例。23例曾行体外冲击波碎石术(ESWL)治疗。本组无隐性结石。所有病例术前均行双肾B超、CT及腹部平片加静脉尿路造影检查。 　　1.2 手术方法 全麻或持续硬膜外麻醉。取截石位,膀胱镜下患侧逆行输尿管导管插至肾,改俯卧位,患肾区垫高。B超定位,一般选择第11肋间或12 肋下缘与腋后线交点作穿刺点，但需根据肾脏位置、肾盏积水程度以及彩色多普勒显示的少血管区而具体确定,以能取净肾内结石为原则。以大约50 cmH2O(1 cmH2O=0.098 kPa)的压力经输尿管导管向肾内注入生理盐水,造成人为的肾积水。超声定位后,通过穿刺架, 18 G穿刺针穿入目标肾盏,见到“尿液”确认穿刺成功,置入专用导丝。筋膜扩张器扩张至F16。顺导丝放入叠套式金属扩张器,逐级扩张至F24。