超声引导经皮肾镜超声气压弹道碎石清石治疗肾结石180例

Paeumatic Combined with Ultrasound Lithotripsy in Percutaneous Nephrolithotomy Under Ultrasound Guidance for Treament of 180 Patients of Renal Calculus

目的：探讨超声引导下经皮肾镜超声联合气压弹道碎石清石治疗肾结石的方法及疗效。方法：超声定位引导下穿刺扩张建立F24经皮肾镜操作通道,在F20.8肾镜直视下应用瑞士产第三代EMS超声气压弹道碎石清石系统治疗肾结石180例,其中鹿角样结石35例;多发结石105例;铸型结石30例;孤立肾结石12例;海绵肾结石9例;移植肾结石1例。结果：180例肾结石Ⅰ期成功建立通道并碎石清石178例,余2例I期建立通道出血,留置造瘘管行Ⅱ期经皮肾镜碎石清石治愈,其中双通道碎石清石治愈8例,Ⅰ期清净结石160例（89%）,结石残留20例,行Ⅱ期经皮肾镜碎石清石治愈7例,辅助ESWL治愈10例,放弃治疗3例。手术时间26~140 min,平均（55±7.5）min,术中失血20~600 ml,平均80 ml,3例输血400 ml,1例术后经皮肾通道间断出血,共输血1 600 ml,术后2周行选择性肾动脉栓塞止血成功,术后发热65例,高热12例,抗炎对症治疗1周体温恢复正常,术后获随访158例,随访时间3~12个月,术前肾功能不全34例,完全恢复正常21例,好转5例,无改善5例,无继发出血及感染,无结石复发。结论：超声引导经皮肾镜超声气压弹道碎石清石术治疗肾结石损伤小、并发症少、安全可靠、疗效确切。

Objective：To evaluate the methods and efficacy of Paeumatic combined with ultrasound lithotripsy in percutaneous nephrolithotomy for treament of renal calculus.Methods：by pneumatic and ultrasonic lithotripsy under ultrasound guidance a total of 180 patients 35 had staghorncalculas,105 had multiple stones,30 had mold stone,12 had solitary renal calcall,9 had Sponge kidney,1 had kidney transplant.Results：178 patients one-time successfully established access other 2 patients secondly operation,8 patients establish two access 160 patients one-time successfully（89%）,20 patients retaihned stone,10 patients the ESWL auxiliary therapy.3 patients abandoning therapy the average operation time was 55±7.5 min（range：26～140 min）,the volume of blood was 80 millilitre（range：20～600 millilitre） 65 patients postoperativepyrexia 12 patients hyperpyrexia,after a week body temperature recover by antibiotic therapy.158 cases were followd up（time3～12 months）,34 patients had kidney function is not complete 21 patients recovery,5 patients improvement,5 patients without improving.Conclusion：Paeumatic combined with ultrasound lithotripsy in percutaneous nephrolithotomy under ultrasound guidance for treatment kidney stones hurt small;less complications;safe and reliable;efficacy reliable.