超声引导经皮肾镜超声弹道联合碎石术治疗肾及输尿管上段结石

Treatment of Renal and Upper Ureteral Calculus under Ultrasound Guided Percutaneous Nephrolithotomy with Ultrasonic and Pneumatic Lithotripsy

目的探讨超声引导建立皮肤肾脏通道,经皮肾镜超声弹道联合碎石术治疗肾及输尿管上段结石的临床疗效。方法对37例肾及输尿管上段结石患者应用超声引导经皮肾镜超声弹道联合碎石术进行治疗,观察其临床疗效、手术并发症、结石清除率等情况,并进行评价分析。结果137例患者均一期成功建立皮肤肾脏通道,128例行一期碎石术,9例行二期碎石术。手术时间为80～190min,平均(95±10)min;术中出血量为50～350mL,平均150mL。术后1w复查,有24例结石残余,结石清除率为82.5%(113/137),无血气胸、腹腔脏器损伤、肾切除等严重并发症发生。结论超声引导经皮肾镜超声弹道联合碎石术治疗肾及输尿管上段结石疗效确切、高效安全、并发症少,值得推广。

Objective To investigate the clinical efficacy on renal and upper ureteral calculus treated with the ultrasound -guided establishment of renal channel and percutaneous nephrolithotomy（PNL） with ultrasonic and pneumatic lithotripsy. Methods 137 cases of renal and upper ureteral calculus were treated with ultrasound guided PNL with ultrasonic and pneumatic lithotriptsy. The clinical data were observed and assessed on clinical efficacy, operative complications, calcium clearance rate, etc. Results 137 cases were established I -phase renal channel, of which, 128 cases received I -phase lithotripsy and 9 cases II -phase lithotripsy. The operation time was ranged from 80 to 190min, averagely（ 95 ± 10） min. Bleeding volume during operation was in the range from 50 to 350ml, averagely 150ml. Re - examination was undertaken 1 week after operation and it was found that 24 cases had calculus residues. Calculus clearance rate was 82.5% （113/137）. There were no serious complications occurred, such as hemopneumothorax, celiac organs injury and nephrectomy. Conclusions Ultrasound guided PNL with ultrasonic and pneumatic lithotriptsy provides definite efficacy on renal and upper ureteral calculus,with high effect and safety and less complication and it deserves to be promoted.