B超引导下经皮肾镜气压弹道联合超声碎石术治疗肾结石118例报告  

Percutaneous nephrolithotripsy with pneumatic and ultrasonic power under B-type ultrasound guidance for treatment of renal calculi(Report of 118 cases)

作　　者：黄木春[1] 詹前策 柳建军[1] 唐伟雄[1] 黄兴端[1] 吴宏[1] 叶木石[1] 扬惠娟[1] 冯湛华[1] 

机构地区：[1]广东医学院附属医院泌尿外科,广东湛江524001 [2]深圳市光明医院泌尿外科

出　　处：《临床泌尿外科杂志》2008年第7期522-524,528,共4页Journal of Clinical Urology

摘　　要：目的:探讨B超引导下经皮肾镜气压弹道联合超声碎石术治疗肾结石的方法、疗效和安全性。方法:2005年7月～2007年9月采用B超引导下经皮肾镜气压弹道联合超声碎石术治疗肾结石118例,其中单侧113例,双侧5例,并对手术操作方法、并发症进行分析。结果:111例116侧成功施行经皮肾穿刺并建立F24经皮肾通道进行Ⅰ期碎石清石术;3例3侧经皮肾穿刺或扩张通道失败改行开放手术;3例3侧由于经皮肾通道扩张出血和1例1侧并发尿脓毒症而行Ⅱ期经皮肾镜碎石术。所有结石均被粉碎,Ⅰ期单侧结石清除率为70.7(87/123侧)。手术时间30～210min,平均(105±51)min。术中失血量10～500ml,平均60ml。3例需输血,输血量平均400ml。术后低、中度发热者36例,高热者4例,经选用合适的抗生素治疗,术后5天内体温恢复正常。2例术后1个月内继发真菌感染,出现肉眼血尿,经抗真菌治疗,血尿消失。结论:B超引导下经皮肾镜气压弹道联合超声碎石术治疗肾结石操作方法安全,疗效可靠。Objective：To discuss the technique and the clinic efficacy as well as safety of management of renal calculi by percutaneous nephrolithotripsy（PCNL） using pneumatic and ultrasonic power under the guide of B-type ultrasound. Methods： From July 2005 to September 2007, The 118 patients with renal calculi underwent PCNL using pneumatic and ultrasonic power under the guide of B-type ultrasound. There were 113 unilateral, 5 bilateral. The procedures and complications were analysed respectively. Results： 116 renal units in 111 patients underwent PCNL at phase I lithotripsy. The punctures from skin to renal were succeed and the F24 renal channels were established successfully in these patients. 3 renal units in 3 cases were changed into open nephrolithotomy due to failing puncture and dilation, the stage II lithotripsy was carried in 3 cases due to bleeding of established percutaneous renal tract and in one owing to urosepsis. All stones were crumbled. The stone-free rate for unilateral renal unit at phase I lithotripsy was 70. 7 % （87/123）. The average operative time was （105±51） min （ range 30 to 210 min）. The average blood loss was 60 ml（range 10～500 ml）. 3cases were had transtusion during the PCNL and averaged 400 ml. Minor pyrexia（〈39℃） was seen in 36 patients, whereas serious pyrexia was noted in four. Conservatively adminstered with appropriate antibiotics the fever dispeared in 40 cases within 5 days postoperatively. Gross hematuria was obserred postoperatively whthin 1 month in two cases secondary urinary fungal infection, Gross hematuria cleared away by using fungal drugs. No severe complications occurred in all patients. Conclusions： It is safe and effective to treat the patients with renal calculi by PCNL using pneumatic and ultrasonic lithotrite under B-type ultrasound guidance.

关 键 词：肾结石 内窥镜检查 经皮肾镜碎石术 

分 类 号：R692.4[医药卫生—泌尿科学]