经皮肾镜超声弹道碎石清石系统一期治疗结石梗阻性脓肾  

Percutaneous nephroscopic pneumatic and ultrasonic lithotripsy in one-phase treatment of renal calculi accompanied with pyonephrosis

作　　者：门晓炜[1] 黄兴[1] 王锐[1] 张雪军[1] 石洪波[1] 余志运[1] 

机构地区：[1]湖北省襄樊市中心医院泌尿外科,襄樊441021

出　　处：《中华腔镜泌尿外科杂志（电子版）》2009年第6期41-43,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨经皮肾镜超声弹道碎石清石系统一期治疗结石梗阻性脓肾的安全性和临床疗效。方法结石梗阻性脓肾31例，均在超声定位及引导下穿刺，建立24F经皮肾通道，肾镜下采用EMS第四代超声弹道碎石清石系统，先用超声吸附装置清理脓液及脓栓，再行超声联合弹道碎石和清石。结果本组均成功建立24F皮肾通道并一期碎石，手术时间75-125min，平均91±12min；处理结石时间35-75min，平均47±8min。本组未出现气胸、肠道损伤等严重手术并发症。1例术后出现高热（T〉39℃），4例术后体温为38-39℃，其余病例术后体温〈38℃。术后1周复查，26例结石取净，5例结石残留，结石清除率83.9％。结论经皮肾镜超声弹道碎石清石系统通过超声吸附装置在低压或无压力状态下吸出脓液、脓栓后，再行碎石和清石，治疗结石梗阻性脓肾安全、有效。Objective To investigate the clinical efficacy and safety of percutaneous nephroscopic pneumatic and ultrasonic lithotripsy in one-phase treatment of renal calculi accompanied with pyonephrosis. Methods 31 cases of renal calculi accompanied with pyonephrosis were punctured under ultrasound guidance, and established a track of 24F. EMS IV LithoClast Master was used. Ultrasonic powered lithotriptor probe with suction was used to clear the liquor puris, and then the combined pneumatic and ultrasonic powered lithotriptor was used to break and clear the calculi. Results The percutaneous renal access of 24F was successfully in all patients and immediate phase I lithotripsy was performed. Average operative time was 91±12min, and average time for stone management was 47±8 min. There was no severe complications occurred. One case suffered from fever over 39℃ and 4 cases with 38℃-39℃ after operation, the other cases was below 38℃. No residual stone fragment in 26 cases, stone free rate was 83.9%. Conclusion Per- cutaneous nephroscopic pneumatic and ultrasonic lithotripsy is a highly efficient procedure and provides fast and safe stone removal in one-phase treatment of renal calculi accompanied with pyonephrosis.

关 键 词：肾结石 经皮肾镜取石术 碎石术 脓肾 

分 类 号：R699[医药卫生—泌尿科学]