经皮肾镜气压弹道联合超声碎石治疗ESWL失败后的输尿管上段结石(附43例报告)

Percutaneous Nephrolithotripsy with Pneumatic and Ultrasonic Power for Upper Ureteral Calculi after Failure of Extracorporeal Shock Wave Lithotripsy

目的探讨输尿管上段结石体外震波碎石（extracorporeal shock wave lithotripsy,ESWL）失败后安全有效的治疗方法。方法43例输尿管上段结石经1-2次ESWL治疗失败后在B超引导下穿刺并扩张建立F24经皮肾通道,在F20.8肾镜下采用瑞士EMS第3代气压弹道联合超声组合式碎石清石系统一期粉碎结石并吸出体外。结果42例手术一期成功取净结石,手术时间35-75min,平均60min;结石清除时间5-20min,平均12min。术中出血量20-150ml,平均50ml。1例因经皮肾穿刺失败改开放手术。1例术后肾包膜下血肿经保守治疗后好转,未输血;1例术后出现感染性发热经加强抗炎治疗后好转。42例随访2-18个月,平均6.4月,无严重出血、感染及肾盂积水,无结石复发。结论经皮肾镜下气压弹道联合超声碎石清石是治疗ESWL失败后的输尿管上段结石安全有效的微创治疗手段。

Objective To find a safe and effective management for upper ureteral calculi after failure of extracorporeal shock wave lithotripsy（ESWL）. Methods Under a F20.8 endoscope （ EMS Ⅲ , Switzerland） , percutaneous nephrolithotripsy was performed with pneumatic and ultrasonic power on 43 patients with upper ureteral calculi after having been treated by ESWL for 1 or 2 times. Results The procedure was completed in 42 of the patients with a mean operation time of 60 rain （35 to 75 rain）, mean time for calculi removal of 12 min （5 to 20 min） , and mean blood loss of 50 ml （20 to 150 ml）. One patient was converted to open surgery because of failure of percutaneous renal puncture. One patient developed haematoma after the procedure and then was cured by conservative therapy without receiving blood transfusion. One patient had fever due to infection and was cured after antibiotic therapy. 42 patients were followed up for 2 to 18 months （mean, 6. 4 months）; none of them had massive hemorrhage, infeetion, hydronephrosis, or recurrence of the calculi during the period. Conclusions Percutaneous nephrolithotripsy with pneumatic and ultrasonic power is safe, minimally invasive, and effective for upper ureteral calculi after failure of ESWL.