经皮肾镜超声气压弹道碎石术治疗上尿路结石164例临床分析

Clinical analysis of 164 cases of upper urinary calculi under percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter

目的探讨经皮肾镜超声气压弹道碎石术治疗上尿路结石的临床疗效,提高上尿路结石的临床治疗水平。方法回顾性分析2009年3月至2010年10月经EMS第三代超声气压弹道碎石术治疗的164例上尿路结石患者的临床资料。结果 164例患者一期均成功建立经皮肾脏通道,157例一期手术成功清除结石,7例患者经二期手术或辅以体外冲击波碎石治愈。手术结石清除率为95.7%,手术时间40～140 min,平均80 min。术中出血量30～360 ml,平均115 ml。术后发热7例,胸腔积液1例,经治疗后均痊愈。术后6～21 d出院,平均11 d。术后随访3个月,无明显并发症发生。结论经皮肾镜超声气压弹道碎石术安全有效,具有结石清除率高、并发症少、恢复快等优点,是治疗上尿路结石的优先选择。

Objective To evaluate the effect of treatment of upper urinary calculi under percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter,and to improve the treatment of upper urinary calculi.Methods Clinical data of 164 cases with upper urinary calculi under percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter were analyzed retrospectively from March 2009 to October 2010 in our hospital.Results The tract nephrostomy was performed in 164 cases successfully in first stage.157 cases were cured under percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter in first stage,and 7 cases required second stage or ESWL treatment.The stone-free rate was 95.7%,operation time was 40-140min（mean 80 min）,and the intraoperative blood loss was 30-360ml（mean 115 ml）.7 cases complicated with postoperative fever,and pleural effusion was found in 1 case after surgrey,they were all cured by correct treatment.The postoperative hospitalization time was 6-21 d（mean 11 d）.There were followed-up for 3 months,and no severe complication was found.Conclusions Percutaneous nephrolithotomy with ultrasonic and pneumatic lithotripter has the advantages of safe and effective,high stone-free ratio,fewer complications and quick recovery,and it is an important choice for the treatment of upper urinary calculi.