运用三代EMS清石系统治疗孤立肾鹿角形结石的安全性及疗效分析  

Efficacy and Safety of Percutaneous Nephrolithotomy for Treatment of Staghorn Stones in Solitary Kideny with Combination Pneumatic and Ultrasonic Lithotrite(The Swiss Lithoclast Master Ⅲ System)

作　　者：胡韶华[1] 王建明 涂娟[1] 许振琦[1] 曹昭礼[1] 

机构地区：[1]南昌市第二医院泌尿外科,南昌330003 [2]余江县人民医院泌外科,江西余江335200

出　　处：《南昌大学学报（医学版）》2010年第7期52-54,共3页Journal of Nanchang University：Medical Sciences

摘　　要：目的探讨运用三代EMS清石系统治疗孤立肾鹿角形结石的疗效及安全性。方法 18例孤立肾鹿角形结石患者在全身麻醉或连续硬膜外麻醉下采用三代EMS清石系统碎石、B超定位点穿刺肾中盏治疗。观察结石的清除率及并发症发生率。结果采用单通道碎石15例,双通道碎石2例,3通道碎石1例;一期手术结石清除率77.0%,总结石清除率88.9%;手术时间55~150 min,平均75 min。2例术中、术后血红蛋白下降1~4 g.L-1,平均（2.0±0.6）g.L-1,予与输血纠正;术后高热者1例,肾功能均有一过性受损,经内科治疗后均恢复到术前状态。无血、气胸及腹腔脏器损伤等严重并发症发生,无死亡病例;平均住院时间14 d,均痊愈出院。结论运用三代EMS清石系统治疗孤立肾鹿角形结石,在B超实时定位穿刺肾中盏行经皮肾镜碎石术（PCNL）,手术时间短、二期取残石手术少、术中出血少、结石清除率高、并发症少、恢复快、住院时间短,是一种安全、有效的方法。Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy（PCNL） for the treatment of staghorn stones in solitary kideny with the swiss Lithoclast master Ⅲ system.Methods Clinical data of 18 patients with staghorn stones were reviewed.In the general anesthesia or epidural anesthesia,the swiss Lithoclast master Ⅲ system and B-ultrasound guided puncture were used in the patients.The stone removal rate and complication rate were the main points of the analysis.Results Of the 18 patients,15 cases underwent one session PCNL through single access tract,2 cases through double access tracts,and 1 case through three access tracts.The stone removal rate by one session PCNL was 77.0%,and the total clearance rate was 88.9%.Mean operation time was 75 minutes（range 55~150 minutes）.Hemoglobin dropped 1~4 g·L-1[mean（2.0±0.6）g·L-1] and blood transfusion was needed during and after operation in 2 cases,and postoperative fever occurred in 1 case.All patients had temporary postoperative renal dysfunction,which could be cured by conservative treatment.No complications happened such as bleeding,pneumothorax and abdominal organ injury,and no deaths occurred.Mean length of hospital stay was 14 days.Conclusion PCNL with the swiss Lithoclast master Ⅲ system and B-ultrasound guided puncture is effective and safe for the treatment of staghorn stones in solitary kidney,and have advantages such as stone removal rate,short procedure,less complications,rapid recovery,less second session PCNL,short hospital stay and less blood loss.

关 键 词：三代EMS 孤立肾 鹿角形结石 

分 类 号：R692.4[医药卫生—泌尿科学]