球囊扩张经皮肾镜超声联合气压弹道碎石术治疗复杂性肾结石

Balloon dilatation percutaneous nephroscopic ultrasound combined with pneumatic lithotripsy for complex renal calculi

目的:探讨球囊扩张经皮肾镜超声联合气压弹道碎石术(PCNL)治疗复杂性肾结石的疗效和安全性.方法:回顾性分析2011年1月~2013年5月65例采用球囊扩张PCNL治疗的复杂性肾结石患者的临床资料,对其手术时间、结石取净率和手术并发症等资料进行分析.结果:61例患者顺利完成Ⅰ期球囊扩张PCNL,手术时间35~86 min,平均62 min,结石取净率为93.8%(61/65);3例患者因肾镜无法到达残石肾盏而终止手术,1例患者因术中出血影响视野而终止手术,均于Ⅰ期手术后6 d在局麻下行Ⅱ期经皮电子膀胱软镜碎石取石术,残石取净率为100%(4/4).随访1~29个月,其中1例鹿角形肾结石合并脊柱侧弯的老年患者因术后继发出血行超选择性肾动脉栓塞术,1例感染性肾结石合并糖尿病的老年患者因术后感染性休克行抗休克治疗,其余63例均无继发性出血、严重感染等并发症.结论:球囊扩张PCNL治疗复杂性肾结石具有手术时间短、结石取净率高、感染率低等优点,是一种高效治疗复杂性肾结石的微创技术.

Objective:To investigate the efficacy and safety of balloon dilatation percutaneous nephroscopic ultra- sound combined with pneumatic lithotripsy(PCNL)for complex renal calculi.Methods:Clinical data of 65 patients with complex renal calculi in our hospital from January 2011 to May 2013 undergoing balloon dilatation PCNL were retrospectively analyzed.Clinical data include the operation time,store-free rate and complications.Results:61pa- tients successfully underwent balloon dilatation PCNL in the first stage,the operation time was 35-86min,and aver- age time was 62 minutes,the calculi-free rate was 93.8%(61/65).The operation of 3 patients were terminated be- cause nephroscope did not reach the calyceal residual calculi,1patient was terminated operation because bleeding dimmed horizon,and 6 days after the first stage they underwent percutaneous electron flexible cystoscope lithotripsy under local anesthesia in the second stage,the calculi-free rate was 100%(4/4).All cases were followed up for 1-29 months.1 aged patient who suffered from stag-horn calculi complicated with scoliosis underwent superselective renal artery embolization because of hemorrhage after operation,1 aged patient who suffered from infectious calculi compli- cated with diabetes mellitus underwent shock treatment because of septic shock,and the other 63 patients had not hemorrhage,severe infection and other complications.Conclusions:The method of balloon dilatation PCNL for com- plex renal calculi has the advantages of short operative time,high calculi-free rate and low infection rate,being a effi- cient minimally invasive surgical technique for complex renal calculi.