彩超对经皮肾镜超声弹道气压碎石术治疗鹿角形肾结石的评价

APPLICATION OF COLOR DOPPLER ON TREATMENT OF RENAL STAGHORN CALCULI BY THE PERCUTANEOUS NEPHROLITHOTRIPSY WITH ULTRASOUND PNEUMATIC LITHOTRIPSY

目的运用彩色多普勒超声(CDU)评价经皮肾镜超声弹道气压碎石术治疗鹿角形肾结石的疗效。方法应用CDU检测35例42个鹿角形肾结石肾脏经皮肾镜超声弹道气压碎石术患者,于手术后3d、7d、1个月观察患肾是否有各种并发症情况以及测量术前术后肾脏肾叶间动脉(IRA)、肾段动脉(SRA)和肾主动脉(MRA)阻力指数RI。结果肾内残留结石及肾积水术后短期内均有较高发生率,观察1个月后发生率大幅减低。肾周积液术后短期内发生率不高,观察1个月后肾周积液发生率大幅减低。肾盏积脓、动静脉瘘、肾微小动脉瘤、胸腔积液、腹腔积液术后短期内发生率较低,观察1个月后消失。在经皮肾镜超声弹道气压碎石术后3d RI均明显增高,术后7d RI逐渐好转,1个月后恢复术前状态。结论 CDU能监测经皮肾镜超声弹道气压碎石术治疗鹿角形肾结石并发症的发生;经皮肾镜超声弹道气压碎石术后鹿角形结石肾出现了短暂肾功能损害,随着时间发展肾功能逐渐好转,直至恢复术前状态。

Objective To evaluate the efficacy of the percutaneous nephrolithotripsy with ultrasound pneumatic lithotripsy for renal staghorn calculi by color Doppler.Methods A total of 35 patients with42 renal staghorn calculi had received the percutaneous nephrolithotripsy with ultrasound pneumatic lithotripsy by color Doppler.Operation complications of the sick kidneys were observed after the operation of 3 days,7 days and 1 month.The resistance index（RI）of the arteriae interlobares renis（IRA）,segmental renal artery（SRA）and main renal artery（MRA）were measured before and after the operation.Results There was high incidence rate of the leaving renal calculi and hydronephrosis in a short time after the operation but it was greatly reduced after 1 month.The incidence rate of perirenal effusion was low and slowed down largely after 1 month,and so was the pyocalyx,arteriovenous fistula,renal small artery aneurysm,pleural effusion and seroperitoneum,but it disappeared after 1 month.Treating with the percutaneous nephrolithotripsy with ultrasound pneumatic lithotripsy,RI was increased obviously after 3 days,improved gradually after 7 days and turned to be the preoperative state after 1 month.Conclusions The color Doppler can monitor the appearance of the operation complications of the renal staghorn calculi treating with the percutaneous nephrolithotripsy with ultrasound pneumatic lithotripsy,The sick kidneys suffer the transient functional lesion,but the renal function turns better gradually to the preoperative state with the time.