体外冲击波碎石术后即刻经皮肾镜取石治疗完全鹿角形肾结石  

Immediate PCNL after ESWL in the treatment of Cata-staghorn Renal Calculi

作　　者：孙家庆[1] 王强[1] 曹成松[1] 吴永第[1] 孙光耀[1] 崔增林[1] 刘大闯[1] 上官卓华[2] 晁亮[1] 王军起[1] 谢叔良[1] 

机构地区：[1]徐州医学院附属第三医院泌尿外科泌尿外科,徐州221003 [2]徐州医学院附属第三医院碎石中心,徐州221003

出　　处：《齐齐哈尔医学院学报》2015年第27期4097-4099,共3页Journal of Qiqihar Medical University

基　　金：徐州市科技计划指导项目(XZZD1359)

摘　　要：目的评价体外冲击波碎石（Extracorporeal shockwave lithotripsy,ESWL）术后即刻经皮肾镜取石（Percutaneous nephrolithotripsy,PCNL）治疗完全鹿角形肾结石的安全性及疗效。方法 2007年6月至2014年6月,采用ESWL术后即刻PCNL的方法治疗完全鹿角形肾结石31例,其中孤立肾完全鹿角形结石2例,双肾完全鹿角形结石2例,合并对侧上尿路结石6例。结石最大径4.1-6.7 cm,平均5.3 cm。控制感染及内科疾病后于术晨先将目标盏及目标盏平行盏、分支细长的肾盏内结石行ESWL,而后即刻在麻醉下建立标准经皮肾通道,行经皮肾镜下气压弹道联合超声碎石清石术。结果 31例33侧完全鹿角形肾结石中,除1例双侧完全鹿角形肾结石因经济原因行单侧手术外,其余32侧均成功建立经皮肾脏通道。一期取净结石24侧,二期取净2侧。结石清除率为81.3%（26/32）。27侧为单通道取石,占84.4%（27/32）。一期手术时间80--200 min,平均118 min。术后输血3例,发热（〉38.5℃）2例,抗感染治愈,无严重并发症发生。术后住院6~26 d,平均10.5 d。结论 ESWL术后即刻PCNL治疗完全鹿角形肾结石提高了结石清除率,缩短了治疗周期,且无严重副作用,是完全鹿角形肾结石安全、有效的微创手术方法。Objective To evaluate the feasibility and safety of immediate PCNL after ESWL in the treatment of cata-staghorn renal calculi .Methods From June 2007 to June 2014, 31 patients were treated by immediate PCNL after ESWL .Of which 2 patients had solidary kidney and 2 patients got calculi in both kidneys . The maximum calculi diameter ranged from 4.1 to 6.7 cm （mean 5.3cm）.After control infection and medical illness, calculi which in the target calyceal calculi or the parallel target branch slender calyceal were firstly treated by ESWL on the surgery morning , then immediately create a standard classic renal channel , combined pneumatic and ultrasound lithotripsy during percutaneous nephrolithotomy .Results Of 33 sides kidney calculi （ 31 patients）, the percutaneous renal access was successfully established under B -type ultrasound guidance for 32 sides, except for a case of bilateral renal calculi underwent unilateral operation because of economic reasons . Calculi were cleared off for 24 sides at phaseⅠlithotripsy and 2 cases cleared off at phase II lithotripsy .Calculi were cleared off for 26 sides, the stone-free rate was 81.3% （26/32）.27 sides were single calculi clear , it occupied 84.4%（27/32）.The average operative time was 118min （80~200min）, 3 cases were supported by blood transfusion postoperatively , 2 cases got fever （〉38.5℃）, they were cured after the treatment of resistance to infection.No pneumothorax , abdominal organ injury and other severe complications occurred .Postoperative hospital stay was 6~26d（mean 10.5 d）.Conclusions The immediate PCNL after ESWL is a safe and effective treatment for cata-staghorn renal calculi .

关 键 词：经皮肾镜取石术 体外冲击波碎石术 肾结石 鹿角形 

分 类 号：R692.4[医药卫生—泌尿科学]