输尿管镜联合经皮肾镜下超声气压弹道治疗上尿路结石疗效观察

Pneumatic ultrasonic lithotripsy by ureteroscope combined percutaneous nephroscope in treating complex upper urinary tract calculi

目的:探讨输尿管镜联合经皮肾镜下超声气压弹道碎石术治疗复杂性上尿路结石的疗效。方法:输尿管镜先处理输尿管结石;B超引导下穿刺,扩张建立F22经皮肾通道,在F20.8肾镜下采用第三代EMS超声气压弹道碎石系统I期粉碎结石并主动吸出。结果:本组30例输尿管结石合并肾结石,手术时间66～177min,平均117min,结石粉碎率100%,取净率83.3%(25/30)。术后随访2～l4个月,平均7.3个月,均无严重并发症,1例肾结石复发(0.7cm),予ESWL治疗。结论:输尿管镜联合经皮肾镜下超声气压弹道I期治疗复杂性上尿路结石效果满意,具有安全、微创、并发症少的特点,值得推广。

Objective ：To investigate the effects of pneumatic ultrasonic lithotripsy by ureteroscope combined percutaneous nephroscope in treating complex upper urinary tract calculi.Methods：Ureteral calculi were treated by uretemscope and pneumatic lithotripsy. Then, the puncture was guided by B ultrasound, percutaneous working channel F22 for nephroscopy was established, urinary tract calculi were fragmented and sucked out on stage Ⅰ by using nephroscope F20.8 and pneumatic ultrasound lithotripsy EMS Ⅲ .Results：Among 30 cases of ureteral calculi accompanied with renal calculi,the clearance time was 66-177 （mean 117）rain.All calculi were successfully fragmented ,the calculi clearance rate was 83.3%（25/30）.No severe complications such as massive haemorrhage, ureteral perforation, conglutinant stenosis happened.During the postoperative follow-up for 2-14 （mean7.3）months, 1 case （renal calculi） recurred.Conclusion：With ureteroseope, percutaneous nephroseope and high effective lithotrity clearance system, the efficiency of fragmenting complex upper urinary tract calculi increases immensely.The simultaneous treatment of urcteral calculi accompanied with renal calculi on stage I is safe and valuable for widespread application in clinic.