经皮肾镜气压弹道联合超声碎石治疗复杂肾结石.docx

经皮肾镜气压弹道联合超声碎石治疗复杂肾结石[摘要]目的：评价经皮肾镜下气压弹道联合超声碎石术治疗复杂性肾结石的方法及疗效。方法：采用瑞士EMS第三代气压弹道联合超声碎石机治疗45例、52侧复杂肾结石患者对其临床资料进行回顾性分析。结果：所有患者均I期建立皮肾通道42例49侧肾脏行I期碎石3例3侧肾脏行II期碎石。平均手术时间82min结石处理时间20~75min。均未出现气胸、肠道损伤等并发症。术后复查KUB平片42侧肾脏I期结石清除干净清除率80.8％；10侧肾脏有结石残留行二次肾镜取石或辅助体外冲击波碎石治疗。结论：经皮肾镜下气压弹道联合超声碎石术处理大的、复杂肾结石是高效、安全的。其能明显提高结石的清除率具有对患者创伤小、恢复快、缩短住院时间等优点并在对残留结石的再次治疗方面有较大的优越性。[关键词]复杂肾结石；经皮肾镜；碎石清石术[中图分类号]R692.4[文献标识码]A[文章编号]1673-7210（2007）08（a）-033-02TreatmentofcomplicatedrenalcalculiunderpercutaneousnephrolithotomywithultrasonicandpneumaticlithotripterXUYing-min1XIONGJie1JIANLing-guo2(1DepartmentofUrologyYishuiCentralHospitalAffiliatedHospitalofShandongMedicalCollegeYishui276400China;2TanbuHealthCenterofMengyinMengyin276200China)[Abstract]Objective:Toevaluatethemethodsandefficacyofpercutaneousnephrolithotomywithultrasonicandpneumaticlithotripter(EMSⅢ)inthetreatingofrenalcalculi.Methods:45patients52renalunitswithcomplicatedrenalcalculireceivedpercutaneousnephrolithotomypreformedbyultrasonicandpneumaticlithotripter.Results:80.8％stone-freeratewasachievedusingone-stageminimallyinvasivepercutaneousnephrolithotomy.Averageoperativetimewas82minutes.Neitherthepneumothoraxnorthebowelhurtscomplicationswerenotedinthepatients.Conclusion:Invasivepercutaneousnephrolithotomyissafeandeffectiveinthetreatmentofmajorrenalcalculi.Highstonefreeratelessinvasioneasyrecoveryandshothospitalizationstayareitsmerits.Italsohasadvantagesoftreatingthepatientswithresidualcalculi.[Keywords]Renalcalculi;Percutaneousnephrolithotomy;Ultrasonicandpneumaticlithotripter自2005年11月5日开始我们采用瑞士EMS三代气压弹道联合超声碎石机治疗复杂肾脏结石45例、52侧取得了满意的疗效现报道如下：1资料与方法1.1临床资料本组患者45例男性26例女性19例；年龄22~72岁平均年龄45.3岁。单发结石8例多发结石27例鹿角状结石10例；结石位于左肾17例右肾21例双肾结石7例。25个肾脏伴有不同程度的肾积水27个肾脏不伴肾积水。结石横经1.5~5.5cm纵经2.0~6.5cm；本组中合并多囊肾1例对侧输尿管结石6例膀胱结石