超声介导下经皮肾镜气压弹道联合超声碎石术治疗鹿角形结石(附600例报告)

Staghorn Renal Stone Treated by Percutaneous Nephrolithotomy with a Combination Pneumatic and Ultrasonic Lithotripsy Under the Guidance of Ultrasonography

目的评价超声介导经皮肾镜下气压弹道联合超声碎石术治疗鹿角形肾结石的临床疗效。方法回顾性分析本院2006-09-2009-07间,应用超声引导经皮肾镜气压弹道联合超声碎石治疗600例鹿角形结石患者的临床资料,对其治疗方法、临床疗效及其优点等资料进行评价。结果600例均Ⅰ期成功建立经皮肾通道,双通道取石456例。手术时间82-180 min,术中失血40-800 mL,Ⅰ期手术结石取尽率为70.3%（422/600）;手术总的结石取尽率88.8%（533/600）,肾盂梗阻解除率100%。本组有428例随访1-6个月,无严重出血、感染及患肾功能丧失,亦无肾周积液、结石复发。结论超声介导下经皮肾镜超声联合气压弹道碎石清石术治疗鹿角形肾结石可明显提高碎石、清石率,缩短手术时间,减少并发症,值得临床推广应用。

Objective We analyzed the results of patients who underwent ultrasound - guided percutaneous nephrolithotomy （PCNL） for staghom calculus. Methods A retrospective analysis was conducted in 600 patients ultrasound - guided percutaneous nephrolithotripsy （PCNL） for staghorn calculus. The clinical data including the calculi - free rate and complications were analyzed. To evaluate the impact of ultrasound - guided pereutaneous nephrolithotripsy on clinical outcomes. Results The calculi free rate was 88.8% （533/600）, The calculi free rate of one - stage operation was 70.3% （422/600）. All obstructive of pelvis were removed.The surgery were not bleeding badly, infection and risk of loss o f renal function and perirenal effusion, calculi recurrence. The spent of operative were 82- 180 rain and the amount of bleeding were 40 - 800 mL. Conclusion Direct ultrasound - guided percutaneous nephrolithoto my is a new method for managing staghoru calculi. It avoids the side effects of operating complication and lessen the spent of operation. It is recommended as a first - line treatment of staghoru calculus.