经皮肾镜下双频双导管碎石系统治疗肾脏铸型感染性结石

Percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotriptor in renal infectious stones

目的探讨经皮肾镜下双频双导管超声碎石系统治疗肾脏铸型感染性结石的安全性与临床疗效。方法回顾性分析2009年7月～2010年6月经皮肾镜下双频双导管超声碎石系统治疗42例(53例次)肾脏铸型感染性结石患者。其中左侧18例,右侧24例。结石大小1.8cm×3.0cm～5.5cm×4.5cm,平均4.3cm×3.5cm。结果采用单通道28例次,Ⅰ期双通道13例次,Ⅱ期双通道12例次,平均手术时间为67min。术中平均出血量为70mL,平均住院天数为11d。术后复查KUB平片,结石取净率为90.5%,术后联合体外冲击波碎石术(ESWL),3个月后,结石总排净率为95.2%。术后输血5例,术后4例出现高热,气胸1例,肾假性动脉瘤1例,均治愈。结论双频双导管超声碎石系统在治疗肾脏铸型感染性结石的过程中,具有加快促进碎石的排出、提高碎石清石效率、缩短手术时间等作用,同时可降低肾盂内压和减少细菌毒素的吸收及有效地减少灌注液外渗导致的并发症,增加了手术安全性。

[Objective] To investigate the safety and efficacy of percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotriptor in renal infectious stones.[Methods] We retrospectively reviewed the clinical data of 42 patients（53 cases） with renal infectious stones treated by percutaneous nephroscopic dual probe ultrasonic intracorporeal lithotriptor from July 2009 to June 2010.18 cases were in the left side,and 24 cases were in the right side.The mean size of stones was 4.3 cm × 3.5 cm,ranged from 1.8 cm × 3.0 cm to 5.5 cm × 4.5 cm.[Results] 28 cases were performed by one tunnel way,13 cases by double tunnel in one stage,and 12 cases by double tunnel in second stage.The mean operating time,blood loss and hospital stay were 67 min,70 mL and 11 d,respectively.The stone clearance rate calculated by KUB after operation was 90.5%,and rose to 95.2% after operation combined with ESWL in 3 months.Postoperative fever happened in 18 cases,blood transfusion in 5 cases,postoperative high fever in 4 cases,pneumothorax in 1 case,renal pseudoaneurysm in 1 case,all of which were cured.[Conclusions] The dual probe ultrasonic intracorporeal lithotriptor device is a safe and efficient tool,which might show special advantages of increasing the stone-free rate,reducing the operative time,cutting down renal intrapelvic pressure,decreasing the incidence of complication related to absorption of bacteriotoxin and extravasation of irrigation fluid,contribute to operation safety.