CAJ | 학술논문

目的探讨超声定位引导经皮肾镜气压弹道联合超声碎石清石术治疗复杂上尿路结石的安全性及其疗效.方法 2005年6月-2009年10月,采用在新型微创经皮肾镜(F20.8)下超声联合气压弹道碎石清石术治疗1 088例复杂上尿路结石患者,其中肾多发结石583例,部分或完全鹿角状结石387例,感染性结石35例,孤立肾结石13例,合并肾功能不全(氮质血症)43例,肾盏憩室结石27例,均在B超引导下穿刺并扩张建立F24皮肾通道,在肾镜下应用瑞士EMS三代气压弹道联合超声碎石清石系统进行碎石并吸出体外,术中B超检查示有残留结石的患者,则在B超引导下进入结石位置肾盏进行碎石.结果 866例患者一期经皮肾镜碎石(PCNL)取净所有结石,一期净石率为79.6%.一期手术的时间为20～180 min,平均手术时间为(45.2±4.7)min;术中失血量为10～450 mL,平均失血量为(40.3±3.5)mL.术后泌尿系X线平片检查显示115例(10.6%)有残留的直径5 mm的结石,行二期PCNL取石;76例(7.0%)患者接受三期PCNL取石.29例(2.7%)术后行辅助体外冲击波碎石治疗.9例术后出现严重出血,8例行超选择性肾动脉栓塞止血后好转,1例因术后严重迟发性出血止血效果不理想行肾切除;1例术后出现肾周巨大血肿,行保守治疗后好转.结论采用经皮肾镜下超声联合气压弹道碎石清石术治疗复杂上尿路结石安全、高效,术中应用B超检查残留结石简便、易行,并能帮助引导肾镜清除残留结石,可显著提高复杂上尿路结石的治疗效果.
목적 탐토초성정위인도경피신경기압탄도연합초성쇄석청석술치료복잡상뇨로결석적안전성급기료효.방법 2005년6월-2009년10월,채용재신형미창경피신경(F20.8)하초성연합기압탄도쇄석청석술치료1 088례복잡상뇨로결석환자,기중신다발결석583례,부분혹완전록각상결석387례,감염성결석35례,고립신결석13례,합병신공능불전(담질혈증)43례,신잔게실결석27례,균재B초인도하천자병확장건립F24피신통도,재신경하응용서사EMS삼대기압탄도연합초성쇄석청석계통진행쇄석병흡출체외,술중B초검사시유잔류결석적환자,칙재B초인도하진입결석위치신잔진행쇄석.결과 866례환자일기경피신경쇄석(PCNL)취정소유결석,일기정석솔위79.6%.일기수술적시간위20～180 min,평균수술시간위(45.2±4.7)min;술중실혈량위10～450 mL,평균실혈량위(40.3±3.5)mL.술후비뇨계X선평편검사현시115례(10.6%)유잔류적직경5 mm적결석,행이기PCNL취석;76례(7.0%)환자접수삼기PCNL취석.29례(2.7%)술후행보조체외충격파쇄석치료.9례술후출현엄중출혈,8례행초선택성신동맥전새지혈후호전,1례인술후엄중지발성출혈지혈효과불이상행신절제;1례술후출현신주거대혈종,행보수치료후호전.결론 채용경피신경하초성연합기압탄도쇄석청석술치료복잡상뇨로결석안전、고효,술중응용B초검사잔류결석간편、역행,병능방조인도신경청제잔류결석,가현저제고복잡상뇨로결석적치료효과.
Objective To evaluate the efficacy and safety of pneumatic combined with ultrasound lithotripsy in percutaneous nephrolithotripsy (PCNL) for treatment of complex upper urinary tract stone. Methods From June 2005 to October 2009, a total of 1,088 patients with complex upper urinary tract stone underwent primary PCNL by pneumatic and ultrasonic lithotripsy under ultrasound guidance. Of the 1,088 patients, 387 had staghorn calculi, 583 had multiple calculi, 35 had infective calculi, and 13 had solitary renal calculi. Ultrasonography was performed after the extraction of all the endoscopically detected stone fragments. The residual fragments were removed under the assistance of B type ultrasonography through pneumatic or ultrasoud lithotripsy. Results Kidney ureter and bladder X-Ray (KUB) demonstrated that 879 cases (79.6%) were stone-free after the primary procedure. Residual calculi (greater than 5 mm) were found in 115 cases (10.6%) by postoperative KUB, and they received a second PCNL; 76 cases (7.0%) received a third PCNL; 29 patients (2.7%) received an ancillary extracorporeal shock wave lithotripsy. The average operative time was (45.2± 4.7) min (ranging 20 - 180 min) ; the average blood loss was (40.3±3.5) mL (ranging 20 - 450 mL). Eight cases had severe hemorrhage postoperatively and were cured with superselective angiographic embolization; only one case who had severe hemorrhage was transferred to open operation. One case had giant perirenal hernatoma postoperatively was cured with conservative therapy. Conclusion Pneumatic combined with ultrasound lithotripsy during percutaneous nephrolithotomy is effective and safe for complex upper urinary tract stone. Intraoperative ultrasonic inspection is simple and easy to perform, which allows sensitive intraoperative detection of residual fragments and can effectively reduce residual stones, enabling immediate removal during the primary procedure or the planning of necessary second look nehroscopy.