输尿管镜联合经皮肾镜下超声气压弹道治疗17例复杂性上尿路结石  

Pneumatic ultrasonic lithotripsy by combined ureteroscope and percutaneous nephroscope in treating complex upper urinary tract calculi in 17 cases

作　　者：郑军[1] 邓晓洪[1] 欧平[1] 王元中[1] 葛冰[2] 舒志松[3] 

机构地区：[1]重庆市中山医院泌尿外科,400013 [2]重庆市中山医院放射科,400013 [3]重庆市中山医院功能科,400013

出　　处：《重庆医学》2008年第13期1411-1412,共2页Chongqing medicine

摘　　要：目的探讨输尿管镜Ⅰ期联合经皮肾镜下超声气压弹道碎石清石术治疗复杂性上尿路结石的方法和疗效。方法输尿管镜处理输尿管结石；B超引导下穿刺，扩张建立F22经皮肾通道，在F20．8肾镜下采用第3代EMS超声气压弹道碎石清石系统争取Ⅰ期粉碎结石并主动吸出。结果术前诊断17例输尿管合并肾结石，清除时间78～156min，平均102min，结石粉碎率100％，取净率82．3％（14／17）。术后随访2～10个月，平均6．5个月，均无严重并发症，如大出血、穿孔、粘连狭窄，亦无复发。结论随着输尿管镜、经皮肾镜以及高效碎石清石系统在临床上的普遍推广，极大提高了复杂性上尿路结石的取石效率，Ⅰ期同时处理输尿管合并肾结石成为现实，具有安全、微创、并发症少的特点，有较好的临床推广价值。Objective To investigate the techniques and effects of pneumatic ultrasonic lithotripsy by combined ureteroscope and percutaneous nephroscope in treating complex upper urinary tract calculi. Methods Ureteral calculi were treated by ureteroscope. Then, the puncture was guided by B ultrasound, percutaneous working channel F22 for nephroscopy was established, urinary tract calculi were tried for fragmenting and sucking out on stage Ⅰ by using nephroscope F20. 8 and pneumatic ultrasound lithotripsy EMSⅢ. Results Among 17 cases of ureteral calculi accompanied with renal calculi diagnosed before operation, the clearance time was 78-156 （mean 102）min. All calculi were successfully fragmented, the calculi clearance rate was 82.3 % （14/17）. No severe complications such as massive haemorrhage, ureteral perforation, conglutinant stenosis happened. Infection or recurrence was observed during the postoperative follow-up for 2- 10（mean 6.5）months,and no recurrence was found. Conclusion With widespread application of ureteroscope,percutaneous nephroscope and high effective lithotrity clearance system in clinic, the efficiency of fragmenting complex upper urinary tract calculi increases immensely. The simultaneous treatment of ureteral calculi accompanied with reanl calculi on stage Ⅰ becomes reality. This method has the advantages of safety, minitrauma and little complication, and has higher value for widespread application in clinic.

关 键 词：输尿管镜联合经皮肾镜 复杂性上尿路结石 超声气压弹道碎石清石术 

分 类 号：R691.4[医药卫生—泌尿科学]