中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2013年
4期
408-410
,共3页
叶友新%邢金春%周中泉%陈实新%刘荣福%陈斌
葉友新%邢金春%週中泉%陳實新%劉榮福%陳斌
협우신%형금춘%주중천%진실신%류영복%진빈
肾结石%鹿角形结石%肾中盏%经皮肾镜碎石术
腎結石%鹿角形結石%腎中盞%經皮腎鏡碎石術
신결석%록각형결석%신중잔%경피신경쇄석술
Renal stones%Staghorn stones%Middle renal calices%Pereutaneous renal lithotripsy
目的 探讨气压弹道联合超声碎石以肾中盏为目标肾盏治疗鹿角形结石的临床效果及安全性.方法 采用气压弹道联合超声碎石以肾中盏为目标肾盏行经皮肾镜碎石术(PCNL)治疗鹿角形结石患者73例,共92侧,其中不完全性鹿角形结石57侧,完全性鹿角形结石35侧.观察结石的排除率及并发症情况.结果 70例(88侧)行一期单通道碎石(中盏)；3例(4侧)行一期双通道碎石[中盏及下盏2例(2侧),中盏及上盏1例(2侧)].一期碎石后共17例(25侧)残留结石,一期结石清除率72.8％ (67/92),其中1例(1侧)残留肾盏结石未进一步处理,自动出院；余16例(24侧)行二期碎石,均为单通道,其中2例(2侧)先行体外冲击波碎石再行PCNL;一、二期碎石后共76侧排尽结石,其中完全性鹿角形结石27侧,不完全性鹿角形结石49侧,总结石清除率82.6％(76/92).手术时间120～ 320min,血红蛋白下降1～4 g/L,术中输血11例,术后输血3例；术后肾盂感染1例,合并肾周感染、单侧分肾功能受损1例.住院时间9～18d.结论 以肾中盏为目标肾盏行PCNL治疗鹿角形结石是有效和安全的,气压弹道联合超声碎石对鹿角性结石的清除率较高,治疗时间短,并发症少.
目的 探討氣壓彈道聯閤超聲碎石以腎中盞為目標腎盞治療鹿角形結石的臨床效果及安全性.方法 採用氣壓彈道聯閤超聲碎石以腎中盞為目標腎盞行經皮腎鏡碎石術(PCNL)治療鹿角形結石患者73例,共92側,其中不完全性鹿角形結石57側,完全性鹿角形結石35側.觀察結石的排除率及併髮癥情況.結果 70例(88側)行一期單通道碎石(中盞)；3例(4側)行一期雙通道碎石[中盞及下盞2例(2側),中盞及上盞1例(2側)].一期碎石後共17例(25側)殘留結石,一期結石清除率72.8％ (67/92),其中1例(1側)殘留腎盞結石未進一步處理,自動齣院；餘16例(24側)行二期碎石,均為單通道,其中2例(2側)先行體外遲擊波碎石再行PCNL;一、二期碎石後共76側排儘結石,其中完全性鹿角形結石27側,不完全性鹿角形結石49側,總結石清除率82.6％(76/92).手術時間120～ 320min,血紅蛋白下降1～4 g/L,術中輸血11例,術後輸血3例；術後腎盂感染1例,閤併腎週感染、單側分腎功能受損1例.住院時間9～18d.結論 以腎中盞為目標腎盞行PCNL治療鹿角形結石是有效和安全的,氣壓彈道聯閤超聲碎石對鹿角性結石的清除率較高,治療時間短,併髮癥少.
목적 탐토기압탄도연합초성쇄석이신중잔위목표신잔치료록각형결석적림상효과급안전성.방법 채용기압탄도연합초성쇄석이신중잔위목표신잔행경피신경쇄석술(PCNL)치료록각형결석환자73례,공92측,기중불완전성록각형결석57측,완전성록각형결석35측.관찰결석적배제솔급병발증정황.결과 70례(88측)행일기단통도쇄석(중잔)；3례(4측)행일기쌍통도쇄석[중잔급하잔2례(2측),중잔급상잔1례(2측)].일기쇄석후공17례(25측)잔류결석,일기결석청제솔72.8％ (67/92),기중1례(1측)잔류신잔결석미진일보처리,자동출원；여16례(24측)행이기쇄석,균위단통도,기중2례(2측)선행체외충격파쇄석재행PCNL;일、이기쇄석후공76측배진결석,기중완전성록각형결석27측,불완전성록각형결석49측,총결석청제솔82.6％(76/92).수술시간120～ 320min,혈홍단백하강1～4 g/L,술중수혈11례,술후수혈3례；술후신우감염1례,합병신주감염、단측분신공능수손1례.주원시간9～18d.결론 이신중잔위목표신잔행PCNL치료록각형결석시유효화안전적,기압탄도연합초성쇄석대록각성결석적청제솔교고,치료시간단,병발증소.
Objective To evaluate the clinical effects and safety of percutaneous nephrolithotomy (PCNL) by middle renal calice used as the main target for the treatment of staghorn stones with the combination of pneumatic and ultrasonic lithotrite.Methods Clinical data of 73 patients underwent PCNL by middle renal calices as main access with 57 incomplete staghorn stones and 35 complete staghorn stones.To observe the situation calculus removal rate and complications.Results Seventy cases (88 sides) underwent one session PCNL by single access tract (middle caliees),3 cases (4 sides) underwent one session PCNL by double access tracts (2 cases by middle and low calices,1 case by up and middle caliees).After the first period of lithoclasty,17 patients (25 sides) residual stones and the stone removal rate 72.8％ (67/92),among these patients,1 case (1 side) had fragments of lateral renal calyeeal stones with no further treatment.Other 16 cases (24 sides)underwent second session PCNL,all were treated by single access tract (middle calices) and 2 cases (2 sides)had extracorporeal shock wave lithotripsy before the second PCNL.After the second period of lithoclasty,76 sides composed of 27 complete staghorn stones and 49 incomplete staghorn stones had no residual fragments with the stone removal rate 82.6％ (76/92).The operative time lasted 120-320 min.Hemoglobin dropped 1-4 g/L,11 cases in the operation procedure and 3 cases after operation needed blood transfusion respectively.One case of renal pelvic infection after operation and 1 case had split renal dysfunction with peri-parenchyma infection.The hospitalization time was 9-18 days.Conclusion It is effective and safe to perform PCNL for staghorn stone by middle calices as a main access.Combining pneumatic and ultrasonic lithotrite will be very useful with high stone clearance,short procedure time and less complications.
