【摘要】 目的探讨输尿管镜下气压弹道碎石机碎石在肾窦内肾盂切开取石术治疗复杂性肾结石中的临床应用价值。方法对12例复杂性肾结石患者采用肾窦内肾盂切开取石术,直视下或用取石钳取出肾盂和各盏结石,用输尿管镜配合气压弹道碎石机击碎残石。结果 12例患者行肾窦内肾盂切开取石术联合输尿管镜下气压弹道碎石机碎石均获得成功。手术时间为116~235 min,术中出血量为50~350 mL。术中无大出血和胸膜、肠道、肾蒂损伤及肾周感染、继发性高血压等并发症发生。10例结石一次性取尽,1例残留小结石于术后1.5个月自行排出,1例残留结石经体外冲击波碎石术治疗后排出。术后随访3~6个月,12例患者复查尿路平片+静脉尿路造影,均无结石残留,原肾积水明显消退,血肌酐正常。结论肾窦内肾盂切开取石术联合输尿管镜下气压弹道碎石机碎石治疗复杂性肾结石,基本达到了取尽结石,同时把肾损伤降到最低。更多还原

【Abstract】 Objective To evaluate the clinical value of intrasinusal pyelolithotomy in combination with ureteroscopic pneumatic lithotripsy in the treatment of complex renal calculi.Methods Twelve patients with complex renal calculi underwent intrasinusal pyelolithotomy.Removal of stones from renal pelvis and renal calyces was performed under direct vision using stone forceps,and ureteroscopic stone fragmentation was performed for the residual stones with pneumatic lithotriptors.Results Intrasinusal pyelolithotomy combined with ureteroscopic pneumatic lithotripsy was successful in all patients.The operative time ranged from 116 to 235 minutes,and intraoperative blood loss ranged from 50 to 350 mL.Complications such as massive hemorrhage,pleural damage,intestinal injury,renal pedicle injury,perirenal infections and secondary hypertension were not observed.Stones were removed at a time in 10 patients,small residual stones were cleared spontaneously 1.5 months after surgery in 1 patients,and residual stones were treated with extracorporeal shock wave lithotripsy in 1 patients.After 3 to 6 months of follow-up,kidney ureter bladder and intravenous pyelography for patients demonstrated that no residual stones were present,hydronephrosis receded,and serum creatinine levels were normal.Conclusion Intrasinusal pyelolithotomy combined with ureteroscopic pneumatic lithotripsy can effectively treat complex renal calculi and minimize renal injury.更多还原