CAJ | 학술논문

目的评价经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石的临床有效性与安全性.方法回顾性分析2010年7月～ 2013年7月施行的22例经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石患者的临床资料.采用B超定位穿刺结石所在的肾盏憩室,应用气压弹道超声击碎结石并取出,同时在美蓝引导下以柱状电极切开狭窄的憩室颈部.术后常规留置肾造瘘管及输尿管支架管引流.术后4周拔除肾造瘘管,3个月后膀胱镜下拔除内支架管.结果 21例行Ⅰ期直接穿刺憩室碎石术,1例因穿刺失败通道出血改为Ⅱ期碎石.术后复查无结石残留,双J管位置良好.手术时间40～ 110min,平均73±24min,术中出血量为60～220ml,平均出血量80mL.术后平均住院时间7d,随访3～24个月,均未发现肾盏憩室内结石再发.结论经皮肾镜超声碎石取石联合盏颈切开一期治疗肾盏憩室结石安全有效,清石率高,创伤小及并发症少.
목적 평개경피신경초성쇄석취석연합잔경절개일기치료신잔게실결석적림상유효성여안전성.방법 회고성분석2010년7월～ 2013년7월시행적22례경피신경초성쇄석취석연합잔경절개일기치료신잔게실결석환자적림상자료.채용B초정위천자결석소재적신잔게실,응용기압탄도초성격쇄결석병취출,동시재미람인도하이주상전겁절개협착적게실경부.술후상규류치신조루관급수뇨관지가관인류.술후4주발제신조루관,3개월후방광경하발제내지가관.결과 21례행Ⅰ기직접천자게실쇄석술,1례인천자실패통도출혈개위Ⅱ기쇄석.술후복사무결석잔류,쌍J관위치량호.수술시간40～ 110min,평균73±24min,술중출혈량위60～220ml,평균출혈량80mL.술후평균주원시간7d,수방3～24개월,균미발현신잔게실내결석재발.결론 경피신경초성쇄석취석연합잔경절개일기치료신잔게실결석안전유효,청석솔고,창상소급병발증소.
Objectives To evaluate the clinical efficacy and safety of percutaneous ultrasonic nephrolithotripsy combined with calyceal diverticulum light neck cutting in the treatment of calyceal diverticular calculi.Methods From Jul 2010 to Jul 2013,the clinical data were analysed 22patients of calyceal divenicular calculi who underwent the percutaneous ultrasonic nephrolithotripsy.Under the guidance Of B-ultrasonogmphy,we penetrated directly into the corresponding diverticulum,with the application of pneumatic lithotripsy and ultrasound fragmented calculi and remove.Under the guidance of the Methylene Blue,the neck of the diverticulum were cut with the help columnar electrodes.After the procedure,trans-diverticular pereutaneous drainage was maintained for 4 weeks,and trans-diverticular ureteral stent was removed 3 months after the operations.Results The percutaneous renal a -ccess to diverticulum was established and phase Ⅰ lithotripsy was performed in 12 patients,phase Ⅱ lithotripsy in 1 patient due to the bleeding during the operation.No residual calculi was observed after the operation and the double J stents was in good position.The whole duration of the operation was 40 ～ 110 minutes with an average of 73 ±-24 minutes,and the blood loss was 60 to 200 ml and 80 ml in average.The average hospital stay was 7 days.All of patients had no recurrence of diverticular calculi during the follow up(ranged 3-6month).Conclusions Percutaneous ultrasonic nephrolithotripsy combined with calyceal diverticulum light neck cutting is safe and effective for calyceal diverticular calculi with a high stone-free rate,and low incidence rate of intraoperative and postoperative complications.