体外冲击波碎石机下经皮肾镜治疗上尿路结石

Fluoroscopy guided percutaneous nephrolithotomy using an extracorporeal shock wave lithotriptor in the treatment of upper urinary tract calculi

目的探讨在体外冲击波碎石机下经皮肾镜取石术(PCNL)治疗肾结石和输尿管上段结石(第三腰椎以上)的方法以及与体外冲击波碎石术(ESWL)联合应用的效果。方法分析47例采用PCNL治疗肾结石和输尿管上段结石(其中2例经PCNL术和ESWL联合应用)的患者资料。男35例,女12例,平均年龄36岁。其中肾盂结石17例,肾盂和肾盏多发结石11例,肾盏结石3例,肾鹿角形结石6例,双肾结石3例,输尿管上段结石7例。2例肾鹿角形结石经PCNL后有一块结石被水流冲至上组肾盏,最后采取ESWL方法击碎排出。结果38例患者一期取石,5例二期取石,三期取石2例。45例均采用单通道取石。结石清除率89%(39/45),平均手术时间125min,平均住院12d。术中大出血2例中转开放手术,术后无继发出血,未见严重并发症。结论PCNL具有创伤小、较安全、出血少、并发症少、恢复快等优点,特别是在体外冲击波碎石机下经皮肾镜取石术治疗肾结石和输尿管上段结石时发生结石向上组肾盏移位、PCNL无法处理时采用ESWL碎石,患者无需搬动就可以碎石,同时可以利用体外冲击波碎石机C臂X光定位下一次穿刺成功,做到一机多用,医疗资源整合利用。

[Objection] To explore the curative effect of combined use of percutaneous nephrolithotomy (PCNL) with extracorporeal shockwave lithotripsy (ESWL) for the treatment of upper urinary tract calculi in patients. [Methods] 35 men and 12 women (mean age 36 years) with renal and upper ureteric stones were treated by PCNL under the guidance of fluoroscopy using an Extracorporeal Shock Wave Lithotriptor, and the ESWL was combined after operation in 2 of 47. Of the patients, 17 were with pelvic stones, 11 with both ...