经皮肾镜配合气压弹道超声碎石机治疗复杂性肾结石

Treatment of complex renal calculi with PCNL associated by pneumatic and ultrasound lithotripsy

目的探讨复杂性肾结石经皮肾镜的治疗方法。方法肾结石21例。男13例,女8例;年龄18～65岁,平均49岁。左肾结石10例(其中孤立肾结石1例),右肾结石7例,双肾结石4例。多发结石16例,肾铸型结石2例(最大径分别为4.6cm和4.3cm),合并UPJ狭窄2例,合并同侧输尿管结石6例,其中上段结石4例,中下段结石2例,对侧输尿管结石2例,均为下段结石,合并肾积水14例,同侧肾切开取石术后复发3例,多次ESWL12例,合并肾功能不全1例。所有病例行经皮肾镜下气压弹道超声碎石取石治疗,合并输尿管中下段结石先行逆行输尿管镜碎石。结果该组21例,肾结石一次取净19例,取净率90.5%,2例残留肾盏小结石,经体外震波碎石后自行排出。平均手术时间1.2h。平均住院时间8.2d。结论经皮肾镜配合气压弹道超声碎石机治疗复杂性肾结石具有明显优势,创伤小,在碎石的同时可以通过碎石机的超声负压吸引装置一期将结石吸出,取石效率大大提高,此方法值得推广。

[Objective] To investigate the methods of PCNL for the treatment of the complex renal calculi. [Method] 21 cases of renal calculi, were treated with PCNL associated by pneumatic and ultrasound lithotripsy. In advance the calculi in the middle and lower ureter which existed simultaneously were treated with ballistic lithotripsy under ureterorenoscopy. [Results] 21 cases in this group, the stones were cleared off in 19 of the 21 cases after the 1 st session, the stone-free rate was 90.5%, only 2 cases of relict little stones in the lower renal calyx were treated by ESWL for the second time and then cleared off. The average operative time was 1.2 hours, average hospitalization being 8.2 days. [Conclusion] Treatment of complex renal calculi with PCNL associated by pneumatic and ultrasound lithotripsy has obvious advantages, less invasion, stones can cleared off by the ultrasound equipment with subpressure simultaneously, the efficiency of stone-free is much increased, and the method Of treatment is worthy of popularization.