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目的探讨B超引导下经皮肾镜钬激光联合超声碎石清石术治疗上尿路结石的安全性和有效性。方法上尿路结石患者376例,其中肾结石患者287例,输尿管上段结石65例。结石最大径0.8～7.5 cm。B超引导下经皮肾穿刺,建立F20工作通道,使用钬激光联合第四代EMS超声碎石清石系统治疗。总结分析手术方法、手术时间、结石清除率及并发症等。结果 376例患者B超引导下1次穿刺成功建立经皮通道,5例因穿刺或扩张时出血明显,及时终止手术。碎石清石总成功率为93.6%(352/376)。287例肾结石患者一期结石清除率为70.0%(201/287),65例输尿管上段结石患者一期结石清除率为95.4(62/65)。二期碎石48例,残留结石最大径0.5～1.0 cm。23例患者行体外震波碎石治疗,残留结石最大径≤0.4 cm。23例患者经体位排石等保守治疗排净。平均手术时间(110.5±28.6)min,术中平均出血量(104±37.2)ml;输血5例。肾造瘘管留置时间平均8 d,术后平均住院时间9 d。大出血3例行选择性肾动脉栓塞治疗后痊愈;术后气胸1例行胸腔闭式引流后痊愈;术后肾周巨大血肿1例,行保守治疗后好转。术后低、中度发热者31例,高热者5例。结论 B超引导下经皮肾镜钬激光联合第四代EMS碎石清石系统治疗上尿路结石创伤小、恢复快、安全高效、并发症少,疗效可靠,是治疗上尿路结石的优先选择。
Objective To investigate the safety and efficacy of percutaneous nephrolithotomy combined with ultrasonography lithotripsy in the treatment of upper urinary tract calculi under B-guided ultrasonography. Methods 376 cases of upper urinary tract stones, including 287 cases of kidney stones, 65 cases of upper ureteral calculi. The largest diameter of stones 0.8 ~ 7.5 cm. B-guided percutaneous renal puncture, the establishment of F20 working channel, the use of holmium laser combined with the fourth generation of EMS lithotripsy clear stone system treatment. To summarize and analyze the surgical methods, operation time, stone clearance rate and complications. Results A total of 376 patients underwent percutaneous transluminal biopsy under the guidance of B-ultrasonography. Five patients had obvious bleeding due to puncture or dilation, and the operation was terminated promptly. Gravel clear stone assembly power was 93.6% (352/376). The stone clearance rate of primary stone in 287 cases of kidney stones was 70.0% (201/287). The stone removal rate of the first stage in 65 cases of upper ureteral calculi was 95.4 (62/65). 48 cases of second gravel, the largest diameter of residual stones 0.5 ~ 1.0 cm. Twenty-three patients underwent extracorporeal shock wave lithotripsy. The maximum diameter of residual stones was ≤0.4 cm. Twenty-three patients were discharged by conservative treatment such as body massaging. The average operation time was 110.5 ± 28.6 min, and the mean intraoperative blood loss was 104 ± 37.2 ml. Blood transfusion was performed in 5 cases. Renal fistula indwelling time average 8 d, average postoperative hospital stay 9 d. 3 cases of hemorrhage were treated with selective renal artery embolization and cured; 1 case of pneumothorax after thoracic closure drainage was cured; 1 case of perinephric hematoma after operation, which improved after conservative treatment. Postoperative low and moderate fever in 31 cases, 5 cases of fever. Conclusion B-guided percutaneous nephroscope holmium laser combined with the fourth generation of EMS lithotripsy stone treatment of upper urinary tract trauma, fast recovery, safe and efficient, less complications, reliable, is the treatment of upper urinary tract stones priority select.