CAJ | 학술논문

目的：探讨超声引导下经皮肾镜取石术（ PCNL ）治疗上尿路结石的安全性、有效性及手术经验。方法回顾分析本科室自2011年6月至2013年6月应用四代EMS超声气压弹道碎石清石系统行超声引导下经皮肾镜取石术治疗上尿路结石患者176例的临床资料，探讨超声引导下经皮肾镜取石术治疗上尿路结石的安全性及有效性，并对治疗效果、术后并发症及手术经验进行总结分析。结果176例上尿路结石患者，男性112例，女性64例，年龄38～75岁（平均51岁）；单侧结石153例，双侧结石23例；其中肾盂、肾盏结石105例，输尿管上段结石71例，肾铸型或鹿角形结石者36例；均采用超声引导下经皮肾镜超声气压弹道碎石清石术，Ⅰ期经皮肾镜碎石术患者164例，Ⅱ期手术者12例，单通道经皮肾镜碎石术患者172例，双通道手术者4例；平均手术时间（95．8±20．6）分钟；术后肾造瘘管留置5～7天， F18三腔硅胶导尿管留置7～9天，平均住院时间13天。Ⅰ期结石清除率85．8％（151/176）。术后发生高热、感染患者9例（5．1％），感染性休克患者2例（1．1％），术后发生大出血输血治疗患者2例（1．1％），发生气胸胸腔积液患者1例（0．06％），经及时规范治疗后病情好转，无手术死亡病例。结论与传统手术取石相比，超声引导下经皮肾镜取石术治疗上尿路结石是安全有效的，其具有结石清除率高、术中术后并发症少、患者创伤小、恢复快、平均住院时间短等优点，是新型、安全、可靠、高效的治疗上尿路结石的术式，值得临床工作中广泛开展。
목적：탐토초성인도하경피신경취석술（ PCNL ）치료상뇨로결석적안전성、유효성급수술경험。방법회고분석본과실자2011년6월지2013년6월응용사대EMS초성기압탄도쇄석청석계통행초성인도하경피신경취석술치료상뇨로결석환자176례적림상자료，탐토초성인도하경피신경취석술치료상뇨로결석적안전성급유효성，병대치료효과、술후병발증급수술경험진행총결분석。결과176례상뇨로결석환자，남성112례，녀성64례，년령38～75세（평균51세）；단측결석153례，쌍측결석23례；기중신우、신잔결석105례，수뇨관상단결석71례，신주형혹록각형결석자36례；균채용초성인도하경피신경초성기압탄도쇄석청석술，Ⅰ기경피신경쇄석술환자164례，Ⅱ기수술자12례，단통도경피신경쇄석술환자172례，쌍통도수술자4례；평균수술시간（95．8±20．6）분종；술후신조루관류치5～7천， F18삼강규효도뇨관류치7～9천，평균주원시간13천。Ⅰ기결석청제솔85．8％（151/176）。술후발생고열、감염환자9례（5．1％），감염성휴극환자2례（1．1％），술후발생대출혈수혈치료환자2례（1．1％），발생기흉흉강적액환자1례（0．06％），경급시규범치료후병정호전，무수술사망병례。결론여전통수술취석상비，초성인도하경피신경취석술치료상뇨로결석시안전유효적，기구유결석청제솔고、술중술후병발증소、환자창상소、회복쾌、평균주원시간단등우점，시신형、안전、가고、고효적치료상뇨로결석적술식，치득림상공작중엄범개전。
Objective To investigate the safety ,effectiveness and surgical experience of the treatment ofupper urinary calculi by ultrasound -guided percutaneousnephrolithotomy lithotomy ( PCNL ) .Methods We retrospec-tively analyzed the data of 176 patients with upper urinary tract calculifrom June 2011 to June 2013 in our depart-mentunderwent PCNL underfour generations EMS stone clearance ultrasound lithotripsy system .Results Of 176 pa-tients (112 male,64 female)with upper urinary tract calculi , aged 38 to 75 years (mean 51 years), 153 cases with unilateral stone , 23 cases with bilateral stones while 105 cases withrenal pelvis or calyx stones and 71 cases with upper ureteral stones , 36 cases with staghorn calculi or kidney mold;All the patients were successfully treated with ultrasound-guided PCNL.of them, 164 cases with primary operative treatment , 12 cases with secondary operative treatment while 172 cases with single -channel PCNL and 4 cases with a dual -channel operation;The mean op-erative time was 95.8 ±20.6 min;The average length of stay was 13 days with5 to 7 days’nephrostomy catheter time and 7 to 9 days ’ F18 three -cavity silicone catheterization time .The first period stone clearance rate was 85.8%(151/176).A total of 14 cases with serious postoperative complications:9 postoperative fever or infection (5.1%), 2 septic shock (1.1%), 2 postoperative bleeding treated with transfusion (1.1%), 1 pleural effusion, pneumothorax (0.06%) .There were no operative deathsafter timely and correctly intervention .Conclusion Com-pared with the traditional stone surgery , ultrasound-guided PCNL in the treatment of upper urinary calculi is safe and effective , which has higher stone clearance rate , fewer postoperative complications , smaller patient trauma , quicker recovery , shorter average length of stay , etc., is a new, safe, reliable and efficient treatment of upper uri-nary calculi surgical procedures .It is worth to carry out extensive clinical use .