摘要
目的探讨超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石的可行性、临床疗效及临床经验。方法 2006年1月至2015年1月北京大学人民医院泌尿外科采用超声引导经皮肾镜、超声气压弹道碎石共治疗完全鹿角状结石患者128例,共142个肾脏鹿角状结石,结石体积：3-179 ml。其中双侧鹿角状结石14例,孤立肾或功能性孤立肾伴鹿角状结石13例,合并肾功能不全22例,合并肾积脓25例,合并脊柱畸形4例。结果 128例患者142个肾脏鹿角状结石手术均获成功,手术时间30-150 min,平均（64.5±39.1）min;一次手术净石率76.8%（109/142）,63.4%（90/142）的肾脏为Ⅰ期单通道,17.6%（25/142）的肾脏为Ⅰ期双通道;16.9%（24/142）的肾脏为Ⅱ期3通道,2.1%（3/142）的肾脏为Ⅲ期4-5通道,9例患者术后行体外冲击波碎石辅助治疗,1个月后净石率为85.2%（121/142）。6例患者（4.2%）术后输血,3例患者（2.1%）行选择性肾动脉栓塞。3例患者（2.1%）出现感染中毒性休克,经抗休克、加强抗炎治疗后好转。3例患者（2.1%）出现一过性肾功能减退,均为孤立肾Ⅰ期双通道取石术后;无一例发生其他严重并发症。结论超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石安全、有效,值得临床推广。
Objective To report our experience and assess the safety and efficacy of ultrasoundguided percutaneous nephrolithotomy（PCNL） with ultrasonic and pneumatic lithotripters for complete renal staghorn stones. Methods From Jan 2006 to Jan 2015, 128 patients（142 kidneys） with complete staghorn stones underwent PCNL, included 14 patients with bilateral renal complete stones,13 patients with solitary or founctional solitary kidney, 22 patients with renal insufficiency, 25 patients with renal empyema, 4 patients with spine malformation, ultrasound-guided PCNL were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters. Results All PCNL procedures were successful. Successful access to the collecting system was 100%. Mean operation time was 64.5±39. 1min（range 30–150）. The primary stone-free rate of PCNL was 76.8%（109/142）. Most of the renal stones（63.4%, 90/142）were managed satisfactorily by a single tract,a second tract was used in 25 renal stones（17.6%, 25/142）. There were 36 auxiliary procedures（24 second PCNL and 3 third PCNL and 9 extracorporeal shock wave lithotripsy）. One month after treatment, the overall stonefree rate was 85.2%（121/142）. Six patients（4.2%） received blood transfusion,three patients（2.1%） received angiography and embolization. Three patients（2.1%） with infective shock were cured by intravenous antibiotics and antishock treatments. Three patients with temporary renal function receded were observed in solitary kidney for two tracts PCNL. No other severe complications occurred. The mean postoperative stay was 5.2 days（range 2–12）. Conclusion： Ultrasound-guided Percutaneous Nephrolithotomy with ultrasonic and pneumatic lithotripters for management of renal complete staghorn stones is safe, effective, and worthy of wider use in clinical practice.
出处
《中华医学超声杂志（电子版）》
CSCD
2015年第6期428-432,共5页
Chinese Journal of Medical Ultrasound(Electronic Edition)
关键词
肾结石
超声检查
介入性
经皮肾镜取石术
超声气压弹道碎石术
Kidney calculi
Ultrasonography
interventional
Percutaneous nephrolithotomy
Ultrasonic and pneumatic lithotripters.
