B超引导下全尿路会师贯通技术联合EMS超声气压弹道碎石系统治疗复杂性肾结石64例分析  

Analysis of 64 cases of complicated renal calculi treated by ultrasoundguided total urinary tract breakthrough technique combined with EMS ultrasonic pneumatic lithotripsy system

作　　者：陈雷振[1] 许海峰[1] 陈树波[1] 魏俊利[1] 张海朝 姬东辉[1] 

机构地区：[1]河北医科大学附属邢台市人民医院泌尿外科,河北邢台054001 [2]邢台县中心医院外科

出　　处：《现代预防医学》2013年第18期3517-3519,共3页Modern Preventive Medicine

基　　金：河北省2012年医学科学研究重点课题项目(20120202)

摘　　要：目的探讨B超引导下全尿路会师贯通技术联合EMS超声气压弹道碎石系统治疗复杂性肾结石的方法、优势。方法复杂性肾结石患者64例,男41例,女23例,平均年龄41（24~64）岁,结石直径1.0~3.5 cm,单发55例,多发9例、鹿角形结石4例、铸型结石11例。左侧29例、右侧30例、双侧5例。其中患肾有手术史2例,合并泌尿系感染26例,肾功能不全8例,其中氮质血症6例、尿毒症2例。均采用B超引导下全尿路会师贯通技术联合超声碎石系统治疗。结果 64例、68侧均一期成功建立24F经皮肾通道,一期碎石61侧,二期碎石3侧,一期碎石中行2通道碎石2侧。双侧同时碎石1例,1例1侧行2通道碎石,平均手术时间103 min。术后平均住院时间6.5 d。一期结石清除率为90.6%（58/64）,总结石清除率为93.7%（60/64）。术中无气胸、腹腔脏器损伤等严重并发症发生。术后3~5 d复查B超或KUB,11例有结石残留,结石最大径0.3~1.2 cm。术后辅以体外冲击波碎石治疗3例,≤4 mm结石9例予药物排石等保守治疗。术后随访1~6个月,拔出双J管时间3~10周。术前肾功能不全8例患者,术后1个月复查血肌酐值恢复正常3例,与术前持平3例（SCr水平与术前比较相差小于5 mmol/L）,加重2例。58例获随访3~24个月,结石无复发。结论 B超引导下全尿路会师贯通技术联合超声碎石治疗复杂性肾结石效率高、并发症少,是治疗复杂性肾结石理想的治疗方案。OBJECTIVE Methods and advantages of combining the ultrasound-guided total urinary tract breakthrough technique with the EMS ultrasonic pneumatic lithotripsy system in the treatment of complicated renal calculi were explored. METHODS 64 patients with complicated renal calculi, including 41 males and 23 females, were studied. Ages of the patients ranged from 24 to 64 years ago, with an average age of 41. Diameters of renal calculi of the patients were between 1.0 and 3.5 cm; 55 cases had a single renal calculus, and 9 cases suffered from multiple renal calculi; staghorn calculi and cast calculi were observed in 4 and 11 cases, respectively. 29 cases had renal calculi on the left side of their body, 30 cases had right-side renal calculi, and 5 cases had bilateral calculi. 2 cases had undergone renal surgery, 26 cases had infection in the urinary system, and 8 cases had renal dysfunction, including 6 azotemia and 2 uremia cases. All 64 patients were subjected to a combination treatment, in which uhrasound-guided total urinary tract breakthrough technique was used in conjunction with the EMS ultrasonic pneumatic lithotripsy system. RESULTS 24F working channels for percutaneous nephroscopy were successfully created on 68 sides of the 64 patients. Phase I lithotripsy on 61 sides, Phase II on 3 sides, and Phase I 2-cen- ter-channel lithotripsy on 2 sides were conducted; in addition, 1 case received a simultaneous bilateral lithotripsy, and 1 other case received a 2-channel-on-l-side lithotripsy. The average surgery time was 103 rain, and the average post-surgerical hospitalization time was 6.5 days. Clearance rate of Phase I lithotripsy was 90.6% （58/64）, and the overall calculi clearance rate was 93.7% （60/64）. No pneumothorax, abdominal organ injury, or other severe complications occurred during the surgeries. The patients were examined 3 to 5 days after an ultrasound or KUB surgery; 11 cases had residual calculi, with the largest calculi diameter being 0.3 to 1.2 cm. 3 cases were supplementarily treated with a

关 键 词：尿路 会师术 肾结石 经皮肾穿刺取石术 

分 类 号：R692.4[医药卫生—泌尿科学]