中华医学超声杂志（电子版）
中華醫學超聲雜誌（電子版）
중화의학초성잡지（전자판）
CHINESE JOURNAL OF MEDICAL ULTRASOUND(ELECTRONICAL VISION)
2015年
6期
428-432
,共5页
熊六林%叶雄俊%马凯%黄晓波%王晓峰
熊六林%葉雄俊%馬凱%黃曉波%王曉峰
웅륙림%협웅준%마개%황효파%왕효봉
肾结石%超声检查,介入性%经皮肾镜取石术%超声气压弹道碎石术
腎結石%超聲檢查,介入性%經皮腎鏡取石術%超聲氣壓彈道碎石術
신결석%초성검사,개입성%경피신경취석술%초성기압탄도쇄석술
Kidney calculi%Ultrasonography,interventional%Percutaneous nephrolithotomy%Ultrasonic and pneumatic lithotripters
目的：探讨超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石的可行性、临床疗效及临床经验。方法2006年1月至2015年1月北京大学人民医院泌尿外科采用超声引导经皮肾镜、超声气压弹道碎石共治疗完全鹿角状结石患者128例，共142个肾脏鹿角状结石，结石体积：3~179 ml。其中双侧鹿角状结石14例，孤立肾或功能性孤立肾伴鹿角状结石13例，合并肾功能不全22例，合并肾积脓25例，合并脊柱畸形4例。结果128例患者142个肾脏鹿角状结石手术均获成功，手术时间30~150 min，平均（64.5±39.1）min；一次手术净石率76.8%（109/142），63.4%（90/142）的肾脏为Ⅰ期单通道，17.6%（25/142）的肾脏为Ⅰ期双通道；16.9%（24/142）的肾脏为Ⅱ期3通道，2.1%（3/142）的肾脏为Ⅲ期4~5通道，9例患者术后行体外冲击波碎石辅助治疗，1个月后净石率为85.2%（121/142）。6例患者（4.2%）术后输血，3例患者（2.1%）行选择性肾动脉栓塞。3例患者（2.1%）出现感染中毒性休克，经抗休克、加强抗炎治疗后好转。3例患者（2.1%）出现一过性肾功能减退，均为孤立肾Ⅰ期双通道取石术后；无一例发生其他严重并发症。结论超声引导、超声气压弹道碎石经皮肾镜治疗肾脏鹿角状结石安全、有效，值得临床推广。
目的：探討超聲引導、超聲氣壓彈道碎石經皮腎鏡治療腎髒鹿角狀結石的可行性、臨床療效及臨床經驗。方法2006年1月至2015年1月北京大學人民醫院泌尿外科採用超聲引導經皮腎鏡、超聲氣壓彈道碎石共治療完全鹿角狀結石患者128例，共142箇腎髒鹿角狀結石，結石體積：3~179 ml。其中雙側鹿角狀結石14例，孤立腎或功能性孤立腎伴鹿角狀結石13例，閤併腎功能不全22例，閤併腎積膿25例，閤併脊柱畸形4例。結果128例患者142箇腎髒鹿角狀結石手術均穫成功，手術時間30~150 min，平均（64.5±39.1）min；一次手術淨石率76.8%（109/142），63.4%（90/142）的腎髒為Ⅰ期單通道，17.6%（25/142）的腎髒為Ⅰ期雙通道；16.9%（24/142）的腎髒為Ⅱ期3通道，2.1%（3/142）的腎髒為Ⅲ期4~5通道，9例患者術後行體外遲擊波碎石輔助治療，1箇月後淨石率為85.2%（121/142）。6例患者（4.2%）術後輸血，3例患者（2.1%）行選擇性腎動脈栓塞。3例患者（2.1%）齣現感染中毒性休剋，經抗休剋、加彊抗炎治療後好轉。3例患者（2.1%）齣現一過性腎功能減退，均為孤立腎Ⅰ期雙通道取石術後；無一例髮生其他嚴重併髮癥。結論超聲引導、超聲氣壓彈道碎石經皮腎鏡治療腎髒鹿角狀結石安全、有效，值得臨床推廣。
목적：탐토초성인도、초성기압탄도쇄석경피신경치료신장록각상결석적가행성、림상료효급림상경험。방법2006년1월지2015년1월북경대학인민의원비뇨외과채용초성인도경피신경、초성기압탄도쇄석공치료완전록각상결석환자128례，공142개신장록각상결석，결석체적：3~179 ml。기중쌍측록각상결석14례，고립신혹공능성고립신반록각상결석13례，합병신공능불전22례，합병신적농25례，합병척주기형4례。결과128례환자142개신장록각상결석수술균획성공，수술시간30~150 min，평균（64.5±39.1）min；일차수술정석솔76.8%（109/142），63.4%（90/142）적신장위Ⅰ기단통도，17.6%（25/142）적신장위Ⅰ기쌍통도；16.9%（24/142）적신장위Ⅱ기3통도，2.1%（3/142）적신장위Ⅲ기4~5통도，9례환자술후행체외충격파쇄석보조치료，1개월후정석솔위85.2%（121/142）。6례환자（4.2%）술후수혈，3례환자（2.1%）행선택성신동맥전새。3례환자（2.1%）출현감염중독성휴극，경항휴극、가강항염치료후호전。3례환자（2.1%）출현일과성신공능감퇴，균위고립신Ⅰ기쌍통도취석술후；무일례발생기타엄중병발증。결론초성인도、초성기압탄도쇄석경피신경치료신장록각상결석안전、유효，치득림상추엄。
ObjectiveTo report our experience and assess the safety and efficacy of ultrasound-guided percutaneous nephrolithotomy (PCNL) with ultrasonic and pneumatic lithotripters for complete renal staghorn stones.MethodsFrom Jan 2006 to Jan 2015, 128 patients (142 kidneys) with complete staghorn stones underwent PCNL, included 14 patients with bilateral renal complete stones,13 patients with solitary or founctional solitary kidney, 22 patients with renal insufficiency, 25 patients with renal empyema, 4 patients with spine malformation, ultrasound-guided PCNL were performed. Stones were fragmented and cleared using a combination of ultrasonic and pneumatic lithotripters.ResultsAll PCNL procedures were successful. Successful access to the collecting system was 100%. Mean operation time was 64.5±39. 1min (range 30–150). The primary stone-free rate of PCNL was 76.8%(109/142). Most of the renal stones(63.4%, 90/142)were managed satisfactorily by a single tract,a second tract was used in 25 renal stones(17.6%, 25/142). There were 36 auxiliary procedures (24 second PCNL and 3 third PCNL and 9 extracorporeal shock wave lithotripsy). One month after treatment, the overall stone-free rate was 85.2%(121/142). Six patients (4.2%) received blood transfusion,three patients(2.1%) received angiography and embolization . Three patients (2.1%) with infective shock were cured by intravenous antibiotics and antishock treatments. Three patients with temporary renal function receded were observed in solitary kidney for two tracts PCNL. No other severe complications occurred. The mean postoperative stay was 5.2 days (range 2–12). Conclusion: Ultrasound-guided Percutaneous Nephrolithotomy with ultrasonic and pneumatic lithotripters for management of renal complete staghorn stones is safe, effective, and worthy of wider use in clinical practice.
