侧卧位经皮肾镜碎石术治疗ESWL失败的输尿管上段结石(附53例报告)  

Percutaneous nephrolithotomy in lateral position for the treatment of upper ureteral stone after failed ESWL(53 cases reported)

作　　者：张永振[1] 陈修德[1] 孙鹏[1] 尉春晓[1] 钟浩[1] 金讯波[1] 

机构地区：[1]山东大学附属省立医院泌尿微创科,济南250021

出　　处：《山东大学学报（医学版）》2013年第4期105-107,112,共4页Journal of Shandong University:Health Sciences

摘　　要：目的探讨侧卧位B超引导经皮肾镜碎石术(PCNL)治疗体外冲击波碎石(ESWL)失败的输尿管上段结石的疗效及安全性。方法回顾性分析2011年6月～2012年3月我院53例ESWL失败的输尿管上段结石患者的临床资料,均予侧卧位B超引导下PCNL治疗,并评估其疗效及并发症。结果 53例患者均顺利完成手术,其中47例患者结石通过手术1次取净。6例术后残余结石患者经进一步辅助治疗,其中4例排净,2例残留结石。首次结石清除率为88.7%,总结石清除率为96.2%。9例发热超过38℃,1例需输血治疗,1例尿脓毒血症致感染性休克,后经综合治疗后恢复良好。未出现动脉性大出血、集合系统穿孔、周围脏器损伤等严重并发症。结论侧卧位B超引导下PCNL治疗ESWL失败的输尿管上段结石具有首次清除率高、手术安全可靠等优点,可作为ESWL失败的输尿管上段结石的一种有效治疗方法。Objective To evaluate the efficacy and safety of ultrasound-guided percutaneous nephrolithotorny （PCNL） in lateral position for the treatment of upper ureteral stone after failed ESWL. Methods From June 2011 to March 2012, 53 patients with upper ureteral stones after failed ESWL underwent ultrasound-guided PCNL in lateral position. Their clinical data and complications were analyzed retrospectively. Results All operations were successfully comple- ted. The stones in 47 patients were completely cleared by the first attempt. 6 patients received further auxiliary measures because of postoperative residual stones after the operation. Stones of 4 patients were completely cleared, and there were 2 patients with residual stones. The primary stone-free rate was 84.2%. The total stone free rate was 96.2%. Major complications occurred inl0 patients after the operation. Overall, 1 case had significant hematuria requiring blood trans- fusion, 9 cases got fever, and 1 case suffered from septic shock. No severe complications occurred. Conclusion The ultrasound-guided PCNL in lateral position for the treatment of upper ureteral stone after failure of ESWL has the advan- tage of high stone clearance rate for the first time and high safety. It is an effective method for the treatment of upper ureteral stone after failed ESWL.

关 键 词：输尿管上段结石 经皮肾镜碎石术 侧卧位 微创 体外冲击波碎石术 

分 类 号：R693.4[医药卫生—泌尿科学]