CAJ | 학술논문

目的：探讨与评价经皮肾镜应用第四代eMs超声气压弹道碎石清石系统治疗复杂性肾结石的安全性与疗效。方法2012年2月至2014年2月采用超声引导穿刺建立通道、肾镜下气压弹道联合超声碎石术治疗103例肾结石患者，其中21例无积水肾结石，巨大结石37例，感染性结石26例，6例曾行肾盂切开取石，3例曾行输尿管切开取石术，5例入院时合并急性梗阻性肾功能衰竭，7例是小儿合并急性肾功能衰竭，以上病人均采用eMs第四代气压弹道联合超声碎石清石系统治疗肾结石，对其手术时间、结石清除率、手术并发症等资料进行分析。结果103例病人均一期建立经皮肾通道，手术结石全部取出率为95.1%，肾盂梗阻均被解除，7例术后大量出血，给予输血400～800ml不等，34例出现术后发热，5例出现败血症，经予以对症治疗后体温恢复正常，随访3个月，无出血、感染、肾周积液。术后平均住院时间9.2d。平均手术时间81min，术后泌尿系X线片检查显示5例残石，2例肾残石经原通道二期取石，2例术后1个月复查结石自行排出,，1例残石较小，碎石和口服药物排石失败，定期随访。结论经皮肾镜应用第四代eMs超声气压弹道碎石清石术治疗复杂性肾结石，不仅安全、高效、微创，而且可提高碎石、清石率，缩短手术时间后和住院时间，降低术后出血、感染等并发症的发生率。
목적：탐토여평개경피신경응용제사대eMs초성기압탄도쇄석청석계통치료복잡성신결석적안전성여료효。방법2012년2월지2014년2월채용초성인도천자건립통도、신경하기압탄도연합초성쇄석술치료103례신결석환자，기중21례무적수신결석，거대결석37례，감염성결석26례，6례증행신우절개취석，3례증행수뇨관절개취석술，5례입원시합병급성경조성신공능쇠갈，7례시소인합병급성신공능쇠갈，이상병인균채용eMs제사대기압탄도연합초성쇄석청석계통치료신결석，대기수술시간、결석청제솔、수술병발증등자료진행분석。결과103례병인균일기건립경피신통도，수술결석전부취출솔위95.1%，신우경조균피해제，7례술후대량출혈，급여수혈400～800ml불등，34례출현술후발열，5례출현패혈증，경여이대증치료후체온회복정상，수방3개월，무출혈、감염、신주적액。술후평균주원시간9.2d。평균수술시간81min，술후비뇨계X선편검사현시5례잔석，2례신잔석경원통도이기취석，2례술후1개월복사결석자행배출,，1례잔석교소，쇄석화구복약물배석실패，정기수방。결론경피신경응용제사대eMs초성기압탄도쇄석청석술치료복잡성신결석，불부안전、고효、미창，이차가제고쇄석、청석솔，축단수술시간후화주원시간，강저술후출혈、감염등병발증적발생솔。
Objective To evaluate the clinical efifcacy and safety of the percutaneous nephrolithotomy lithotomy( PCNL) and fourth generations of eMs treatment for complexity of kidney stones.Methods 103cases of renal calculus ,21cases of renal stone without hydronephrosis, 6 cases had undergone nephrolithotomy,3 cases had undergone ureterolithotomy,5cases were acute ranal failur ,7cases were chilren with acute renal failur , Pcnl guided by B-ultrasonography and with fourth generations of eMs treatment for renal calculus and upper ureteral calculus. retrospectively analyzed the time of the operation ,the clearance of the stone ,the complication.Results Homogenization of 103cases in this group to establish percutaneous renal access,the total rate of clear of stone was95.1% ,the rate of remove thepyelic obstruction was 100%.7case happened Massive bleeding postoperation, blood transfusion were given 400ml,800ml for 2 cases,34cases had fever ,5cases had happened septicaemia,the patients were discharged from hospital after operationin were 9.2 days. the mean operation time was 81minutes.after operation,urinary system X-ray showed 5cases with residual stones,and 2cases did stageⅡPcnl from previous tunnel,residual stones in the ureter in 1 cases fall into the ureter hol-mium laser lithotripsy. they were followed up for 1~6 months,during the period,no hemorrhage,no infection,no lfuidify. Conclusion Pcnl combined with fourth generations of eMs can increase the rate of gravel,stone clearance rate,shorten the operation time,decreased the hemorrhage and fever after surgery,is a safe ,mini-invasiv and effec-tive method for the treatment of renal calculus and upper ureteral calculus.