【作者】 马勇；

【导师】 徐祗顺；

【作者基本信息】 山东大学 ， 泌尿外科， 2008， 硕士

【摘要】 目的:探讨B超引导经皮肾镜气压弹道联合超声碎石清石术处理肾及输尿管上段结石的方法和疗效。方法:自2008年1月～2008年10月单县中心医院泌尿外科采用B超引导下经皮肾镜气压弹道碎石联合超声碎石清石术Ⅰ期治疗肾及输尿管上段结石50例54侧。男,31例,女,29例,年龄14～65岁,平均42岁。单侧46例,双侧4例。单纯输尿管上段结石21例22侧,肾单发结石20例22侧,肾铸型或多发结石2例,肾结石合并输尿管上段结石7例8侧。所有病例都是阳性结石,术前都行腹部平片+静脉肾盂造影及B超确诊。腹部平片(KUB)测量结石最大径1.2～5.5cm,平均3.2 cm。B超示2例3侧无肾积水,48例51侧合并肾积水,集合系统分离1.2～6.5cm。术中在B超引导下穿刺并扩张建立F24经皮肾通道,在F20.8肾镜下采用瑞士EMSⅢ代气压弹道联合超声组合式碎石清石系统,Ⅰ期粉碎结石并吸出体外。结果:全部病例均Ⅰ期手术成功,Ⅰ期手术单侧结石清除时间10～180min,平均45 min。术中失血约20～400 ml,平均60 ml。术后5天腹部平片与术前对照,在肾区与输尿管走行区未发现高密度结石影为结石取净。单纯输尿管上段结石及肾单发结石Ⅰ期手术单侧结石取净率95.24%、95%;肾铸型或多发结石及肾结石合并输尿管上段结石Ⅰ期手术单侧结石取净率50%、71.43%,总的Ⅰ期手术单侧结石取净率90%(45/50)。术后有结石残留5例(10%),直径均小于0.8cm,辅助施行体外冲击波碎石或保守治疗。4例(8%)术后短期发热,体温最高39.2℃,经抗感染治疗,术后5 d内体温降至正常。1例术后6天出现严重出血,活动加剧,经止血、输血,绝对卧床休息保守治疗好转。术后肾功能及肾积水情况较术前改善。随访1～8个月,无严重手术并发症。无严重出血及感染。1例术后3个月复查B超、腹部平片结石复发,结石约0.8cm,位于下肾盏,无积水,予保守治疗,未行进一步处理,在继续随访观察中。结论:B超引导经皮肾镜具有定位准确,工作通道建立方法安全简便,无X线对人体损害;气压弹道碎石联合超声碎石清石术处理肾及输尿管上段结石具有碎石高效安全、结石清除率高、创伤小、恢复快、并发症少等特点,值得临床推广应用。更多还原

【Abstract】 Objective To investigate the clinical efficacy of combined pneumatic and ultrasoud lithotripsy for treatmentment of renal and upper ureteral calculi during percutaneous nephrolithotomy under ultrasound guidance.Methods Fifty patients(31 males,29 females) were treated with PCNL from Jan 2008 to Oct 2008.The mean stone diameter was 3.2(1.2-5.5)cm.The kidney was Punctured under ultrasonography guidance.The working channel was dilated until an F24 metal sheath was positioned.Under F20.8 nephroscopy,ultrasonic,pneumatie probes or combined were used for lithotripsy.Results All the cases were cured successfully in one stage.The mean operative time was 45 min(range 10-180 min).The average blood loss was 60 ml(range 20-400 ml).One cases had severe hemorrhage postoperatively.No severe infection was observed.The calculi degradation rate was 100%,and the calculi clearance rate was 90%(45/50) while 2 cases had a residual calculi smaller than 0.8 cm due to an inaccessible location.These 2 cases were cured by ESWL.No severe complications occurred during nephrolithotomy after follow-up of 1 to 8 months.Conclusion PCNL under ultrasound guidance for treatment of upper urinary tract calculi can obtain a accurate locating,and the construction of tunnel is safe and convenient.Without X ray damage human body.A combined pneumatic and ultrasound lithotripsy device deal with complex upper urinary tract calculi during percutaneous nephrolithotomy appears to be efficacious and safe for calculi clearance with quick recovery period and less complication.更多还原