B超引导经皮肾镜气压弹道联合超声碎石术治疗无积水肾结石的临床分析

The clinical analysis of the treatment of un-hydronephrotic renal calculi by percutaneous pneumatic lithotripsy combined with ultrasonic lithotripsy

目的探讨B超引导经皮肾镜气压弹道联合超声碎石术对于无积水肾结石的应用效果。方法选择我院2013年1月~2014年12月收治的符合条件的99例无积水肾结石患者为研究对象,在B超引导下以经皮肾镜气压弹道联合超声碎石术对患者进行治疗。另选取我院2012年6月~2012年12月行普通经皮肾镜碎石术的无积水肾结石50例作为对照。记录两组的围手术期情况,对比术前术后的肾功能指标,观察并记录术后并发症情况。结果观察组的一期碎石率、单一碎石通道率均显著高于对照组,而手术时间、术中出血量、住院时间则明显低于对照组,差异均有统计学意义（P〈0.05）。两组患者的平均血尿素氮（BUN）、血肌酐（Scr）、血钠及24h尿量相比术前差异具有统计学意义（P〈0.05）,但观察组的BUN、血钾改善情况显著优于对照组（P〈0.05）;而血钾与肾小球滤过率（GFR）相比术前未发生显著变化（P〉0.05）。本组患者未出现气胸、腹腔脏器损伤、尿瘘等严重并发症,观察组并发症发生率显著低于对照组,差异有统计学意义（P〈0.05）。结论 B超引导经皮肾镜气压弹道联合超声碎石术对于无水肾结石的一期碎石成功率高,可显著改善患者肾脏功能,且并发症少,值得进一步研究。

Objective To investigate the effect of percutaneous pneumatic lithotripsy combined with ultrasonic lithotripsy in the treatment of patients with un-hydronephrotic renal calculi. Methods 99 patients with unhydronephrotic renal calculi were treated by percutaneous pneumatic lithotripsy combined with ultrasonic lithotripsy guided by ultrasound.Another 50 patients treated by normal ultrasonic lithotripsy were chossen as comparisons.Perioperative situation and postoperative complications were recorded,and a comparision between preoperative and postoperative renal function indexes were observed. Results As for the Observation group percutaneous renal access was successfully established in 99 patients,of which 92 cases（92.9%） were successfully treated by one-time lithotripsy,88 patients were established by single channel to meet the requirements of the gravel.Hence,the first phase of the gravel rate and the single stone rate were significantly higher than those in the control group,while the operation time,bleeding volume and hospitalization time were significantly lower than those in the control group,After surgery,the mean BUN,Scr,serum sodium and 24 h urine volume were significantly improved compared with the preoperative ones（P 〈0.05）,but the improvement of BUN and serum potassium in the observation group was significantly better than that in the control group（P〈0.05）;While the serum potassium and GFR were not significantly changed（P 0.05）.There were no complications as pneumothorax,abdominal organ injury or fistula,only 2 cases of hematoma and 1 case of incision infection,which were relieved after symptomatic treatment. Conclusion Ultrasound guided percutaneous pneumatic lithotripsy combined with ultrasonic lithotripsy has the advantages of good curative effect,safety and reliability,which is worthy of further promotion.