气压弹道联合超声碎石治疗鹿角形结石73例分析

Analysis of 73 cases for treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite

目的探讨气压弹道联合超声碎石以肾中盏为目标肾盏治疗鹿角形结石的临床效果及安全性。方法采用气压弹道联合超声碎石以。肾中盏为目标肾盏行经皮肾镜碎石术（PCNL）治疗鹿角形结石患者73例，共92侧，其中不完全性鹿角形结石57侧，完全性鹿角形结石35侧。观察结石的排除率及并发症情况。结果70例（88侧）行一期单通道碎石（中盏）；3例（4侧）行一期双通道碎石[中盏及下盏2例（2侧），中盏及上盏1例（2侧）]。一期碎石后共17例（25侧）残留结石，一期结石清除率72．8％（67／92），其中1例（1侧）残留肾盏结石未进一步处理，自动出院；余16例（24侧）行二期碎石，均为单通道，其中2例（2侧）先行体外冲击波碎石再行PCNL；一、二期碎石后共76侧排尽结石，其中完全性鹿角形结石27侧，不完全性鹿角形结石49侧，总结石清除率82．6％（76／92）。手术时间120—320min，血红蛋白下降1—4g／L，术中输血11例，术后输血3例；术后肾盂感染1例，合并肾周感染、单侧分肾功能受损1例。住院时间9～18d。结论以肾中盏为目标肾盏行PCNL治疗鹿角形结石是有效和安全的，气压弹道联合超声碎石对鹿角性结石的清除率较高，治疗时间短，并发症少。

Objective To evaluate the clinical effects and safety of percutaneous nephrolithotomy （PCNL） by middle renal ealice used as the main target for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite. Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones. To observe the situation calculus removal rate and complications. Results Seventy cases （88 sides ） underwent one session PCNL by single access tract （middle caliees） ,3 cases （4 sides） underwent one session PCNL by double access tracts （2 cases by middle and low ealiees, 1 case by up and middle caliees）. After the first period of lithoclasty, 17 patients （25 sides） residual stones and the stone removal rate 72. 8% （67/92） , among these patients, 1 case （1 side） had fragments of lateral renal ealyeeal stones with no further treatment. Other 16 cases （24 sides） underwent second session PCNL, all were treated by single access tract （middle calices） and 2 cases （2 sides） had extracorporeal shock wave lithotripsy before the second PCNL. After the second period of lithoclasty,76 sides composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stone removal rate 82. 6% （76/92）. The operative time lasted 120 -320 min. Hemoglobin dropped 1 -4 g/L, 11 cases in the operation procedure and 3 cases after operation needed blood transfusion respectively. One case of renal pelvic infection after operation and 1 case had split renal dysfunction with peri-parenchyma infection. The hospitalization time was 9 - 18 days. Conclusion It is effective and safe to perform PCNL for staghorn stone by middle calices as a main access. Combining pneumatic and ultrasonic lithotrite will be very useful with high stone clearance, short procedure time and less complications.