中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2008年
10期
678-680
,共3页
郭丰富%邵志强%王广健%谭善峰%何相飞%刘鸿君%王健明%张淑建%李扬%孙富广
郭豐富%邵誌彊%王廣健%譚善峰%何相飛%劉鴻君%王健明%張淑建%李颺%孫富廣
곽봉부%소지강%왕엄건%담선봉%하상비%류홍군%왕건명%장숙건%리양%손부엄
肾造口术,经皮%碎石术
腎造口術,經皮%碎石術
신조구술,경피%쇄석술
Nephrostomy,percutaneous%Lithotripsy
目的 探讨B超引导下经皮肾镜气压弹道联合超声碎石术治疗复杂性肾结石的临床疗效.方法 复杂性肾结石患者382例.男218例,女164例,平均年龄41(4～74)岁.均行B超、KUB加IVU检查,行CT检查285例,逆行肾盂造影检查9例.结石直径1.0～7.5 cm.结石单发65例、多发317例、鹿角形结石95例.左侧169例、右侧140例、双侧73例.其中患肾有手术史52例,合并泌尿系感染127例,肾功能不全31例,其中氮质血症期18例、尿毒症前期13例.均采用B超引导下经皮肾镜气压弹道超声碎石清石系统治疗.结果 382例405侧均一期成功建立24 F经皮肾通道(1例为16 F,应用8.9 F输尿管镜),一期碎石397侧,二期碎石8侧,一期碎石中行2通道碎石14侧.双侧同时碎石23例,2例1侧行2通道碎石,3例第2侧行二期碎石.平均手术时间93min.术中出血量平均70 ml,输血9例.术后平均住院时间5.5 d.一期结石清除率为89.9%(364/405),总结石清除率为91.8%(372/405).术中无气胸、腹腔脏器损伤等严重并发症发生.术后3～5d复查B超或KUB,41例有结石残留,结石最大径0.3～2.5 cm.8例8侧于术后5～7 d行二期碎石,14例残余结石最大径0.5～1.5 cm者辅以体外冲击波碎石治疗,≤4 mm结石19例予药物排石等保守治疗.术后随访1～3个月拔除双J管.术前肾功能不全31例患者,术后1个月复查血肌酐值恢复正常25例.146例获随访3～24个月,结石无复发.结论 B超引导下经皮肾镜气压弹道联合超声碎石效率高、并发症少,是治疗复杂性肾结石的重要方法.
目的 探討B超引導下經皮腎鏡氣壓彈道聯閤超聲碎石術治療複雜性腎結石的臨床療效.方法 複雜性腎結石患者382例.男218例,女164例,平均年齡41(4～74)歲.均行B超、KUB加IVU檢查,行CT檢查285例,逆行腎盂造影檢查9例.結石直徑1.0～7.5 cm.結石單髮65例、多髮317例、鹿角形結石95例.左側169例、右側140例、雙側73例.其中患腎有手術史52例,閤併泌尿繫感染127例,腎功能不全31例,其中氮質血癥期18例、尿毒癥前期13例.均採用B超引導下經皮腎鏡氣壓彈道超聲碎石清石繫統治療.結果 382例405側均一期成功建立24 F經皮腎通道(1例為16 F,應用8.9 F輸尿管鏡),一期碎石397側,二期碎石8側,一期碎石中行2通道碎石14側.雙側同時碎石23例,2例1側行2通道碎石,3例第2側行二期碎石.平均手術時間93min.術中齣血量平均70 ml,輸血9例.術後平均住院時間5.5 d.一期結石清除率為89.9%(364/405),總結石清除率為91.8%(372/405).術中無氣胸、腹腔髒器損傷等嚴重併髮癥髮生.術後3～5d複查B超或KUB,41例有結石殘留,結石最大徑0.3～2.5 cm.8例8側于術後5～7 d行二期碎石,14例殘餘結石最大徑0.5～1.5 cm者輔以體外遲擊波碎石治療,≤4 mm結石19例予藥物排石等保守治療.術後隨訪1～3箇月拔除雙J管.術前腎功能不全31例患者,術後1箇月複查血肌酐值恢複正常25例.146例穫隨訪3～24箇月,結石無複髮.結論 B超引導下經皮腎鏡氣壓彈道聯閤超聲碎石效率高、併髮癥少,是治療複雜性腎結石的重要方法.
목적 탐토B초인도하경피신경기압탄도연합초성쇄석술치료복잡성신결석적림상료효.방법 복잡성신결석환자382례.남218례,녀164례,평균년령41(4～74)세.균행B초、KUB가IVU검사,행CT검사285례,역행신우조영검사9례.결석직경1.0～7.5 cm.결석단발65례、다발317례、록각형결석95례.좌측169례、우측140례、쌍측73례.기중환신유수술사52례,합병비뇨계감염127례,신공능불전31례,기중담질혈증기18례、뇨독증전기13례.균채용B초인도하경피신경기압탄도초성쇄석청석계통치료.결과 382례405측균일기성공건립24 F경피신통도(1례위16 F,응용8.9 F수뇨관경),일기쇄석397측,이기쇄석8측,일기쇄석중행2통도쇄석14측.쌍측동시쇄석23례,2례1측행2통도쇄석,3례제2측행이기쇄석.평균수술시간93min.술중출혈량평균70 ml,수혈9례.술후평균주원시간5.5 d.일기결석청제솔위89.9%(364/405),총결석청제솔위91.8%(372/405).술중무기흉、복강장기손상등엄중병발증발생.술후3～5d복사B초혹KUB,41례유결석잔류,결석최대경0.3～2.5 cm.8례8측우술후5～7 d행이기쇄석,14례잔여결석최대경0.5～1.5 cm자보이체외충격파쇄석치료,≤4 mm결석19례여약물배석등보수치료.술후수방1～3개월발제쌍J관.술전신공능불전31례환자,술후1개월복사혈기항치회복정상25례.146례획수방3～24개월,결석무복발.결론 B초인도하경피신경기압탄도연합초성쇄석효솔고、병발증소,시치료복잡성신결석적중요방법.
Objective To report the experiertce of management of complicated renal stones by percu taneous nephrolithotripsy (PCNL) with pneumatic and ultrasonic power by ultrasound guidance. MethodsThree hundred and eighty two cases(218 males,164 females,4 74 years) who underwent PCNL by u sing the third generation Swiss LithoClast Master for kidney stones from 2004 to 2007 were retrospectivelyreviewed. Clinical data including operation time,stone free rate and complications were analyzed. ResultsPhaseⅠlithotripsy was performed in 397 sides and delayed phaseⅡlithotripsy in 8 sides. Twenty three casesunderwent simultaneous bilateral PCNL. The operation time ranged from 70 to 190 min,average time was(93±11)min. Nine cases needed blood transfusion. Severe complications did not occur during operations.Stone free rate was 91.8% (372/405). Residual stone fragment was found in 33 cases after delayed phase Ⅱlithotripsy and 14 cases received adjuvant extracorporeal shock wave lithotripsy. One hundred and forty sixcases were followed up for 3 to 24 months and showed no recurrence. Conclusion PCNL with pneumaticand ultrasonic power could be an efficient treatment for complicated kidney stones.
