B超引导经皮肾镜大功率钬激光碎石治疗鹿角型肾结石  

Treatment of staghorn stones by percutaneous nephrolithotomy with high-power holmium-laser under the guidance of ultrasonography

作　　者：温晓飞[1] 温机灵[1] 仇广明[1] 陈卫华[1] 王跃闽[1] 

机构地区：[1]同济大学附属东方医院泌尿外科,上海200120

出　　处：《同济大学学报（医学版）》2010年第6期55-58,63,共5页Journal of Tongji University(Medical Science)

摘　　要：目的探讨鹿角型结石在B超引导下皮肾通道的建立,以及采用20～24 F多通道大功率钬激光碎石的临床疗效和安全性。方法 44例(47侧)鹿角型肾结石,B超引导下穿刺目标肾盏,建立20～24F皮肾通道,经皮输尿管镜下采用45～70 W大功率钬激光碎石,较大残留结石增加16 F通道取石。对穿刺通道数目、位置,手术时间,手术并发症,结石清除率等临床资料进行分析。结果 47侧均成功建立皮肾通道,其中单通道28侧,双通道15侧,三通道4侧。46侧完成经皮肾镜取石术,一期完成取石者9侧,二期取石35侧,三期取石2侧。结石取净率76.1%,残留结石患者中2例经ESWL治疗后排出。输血4例,其中1例行介入肾动脉栓塞治疗。术后发热>38.5℃者2例。胸腔积液1例。无腹腔脏器损伤。结论采用B超引导穿刺经皮肾镜大功率钬激光碎石治疗鹿角型结石安全有效,并发症少。对于结石体积巨大或合并感染者,采用分期手术有助于降低出血和重症感染的风险。Objective To evaluate the establishment of nephrostomy tract under the guide of ultrasound and to assess the efficiency and safety of percutaneous nephrolithotomy（PCNL） with high-power holmium-laser（20-24 F） on treatment of staghorn calculi.Methods Forty-four patients（47 sides） with staghorn calculi were treated by percutaneous nephrolithotomy in 20-24 F nephrostomy tracts with 45-70 W high-power holmium-laser.The number and position of nephrostomy tract, operative time,complication of the operation and the stone-free rate were analyzed retrospectively. Results The establishments of nephrostomy tract under me guide of ultrasound were successful in all 47 sides,in which 28 sides were managed satisfactorily by a single tract,a second tract was used in 15 sides and the third tract was used in 4 sides.PCNL were achieved in 46 sides.Nine sides were achieved by using one-stage percutaneous nephrolithotomy,35 sides were two-stage and 2 sides were third-stage.The total stone-free rate was 76.1%.Four cases with staghorn calculi required blood transfusion,in which one case under went intervention embolism.Residual stones were discharged in 2 cases after extracorporeal shock wave lithotripsy（ESWL） treatment.Two cases had postoperative fever（38.5℃）. Hydrothorax occurred in one case.No other major complications occurred such as colon,liver or spleen damage.Conclusion Percutaneous nephrolithotomy with high-power holmium-laser under the guide of ultrasound is safe and effective on treatment of staghorn calculi and its complication is limited. It is beneficial to reduce the risks of bleeding and severe infection by staged PCNL for patients with enormous staghorn calculi or preoperative infection.

关 键 词：肾结石 肾造口术 经皮 碎石术 激光 

分 类 号：R692.4[医药卫生—泌尿科学]