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目的评价彩超引导下微创经皮肾镜治疗上尿路结石的临床疗效和安全性。方法收集2010年10月—2013年7月在彩超引导下经皮肾镜微创治疗的肾结石患者152例,其中应用第四代汇福康国产超声碎石机(型号CQS-01)125例,应用Cyberwand双导管碎石机27例。记录手术时间,观察清石率、住院时间和并发症。结果152例患者均成功建立经皮肾通道,147例一期碎石,4例二期碎石(术中出血),1例中转开放手术(并发气胸)。应用CQS-1时采用大功率钬激光碎石18例,超声碎石85例,超声联合气压弹道碎石22例,手术时间分别为(46±17)min,(65±28)min和(72±25)min,应用Cyberwand双导管碎石机手术时间为(60±30)min。一期清除结石125例(89.2%),17例术后结合体外冲击波碎石(ESWL)排净,10例有少量结石残留。一期取净结石患者平均住院时间7.6 d。无毗邻脏器损伤。结论彩超引导下经皮肾镜微创治疗肾结石,具有安全,易操作,高效,并发症少等优势,值得临床推广应用。
Objective To evaluate the clinical efficacy and safety of minimally invasive percutaneous nephrolithotomy guided by color Doppler ultrasonography in the treatment of upper urinary tract calculi. Methods A total of 152 patients with nephrolithiasis underwent ultrasound-guided percutaneous nephrolithotomy were collected from October 2010 to July 2013. Among them, 125 cases of the fourth generation of Huifukang homemade ultrasound lithotripsy (model CQS-01) , Application of Cyberwand double catheter crushing machine in 27 cases. The operation time was recorded, the rate of clear stone, hospital stay and complications were observed. Results All 152 patients were successfully established percutaneous renal access, 147 cases of first gravel, 4 cases of second gravel (intraoperative bleeding), 1 case of open surgery (with pneumothorax). In the application of CQS-1, 18 cases of high-power holmium laser lithotripsy, 85 cases of ultrasonic lithotripsy, 22 cases of ultrasound combined with pneumatic lithotripsy were operated for (46 ± 17) min, (65 ± 28) min and ± 25) min, the application of Cyberwand double catheter lithotripsy operation time was (60 ± 30) min. 125 cases (89.2%) of the stones were removed in one stage, 17 cases were discharged with extracorporeal shock wave lithotripsy (ESWL) and 10 cases had a small amount of residual stones. The average hospital stay in patients with net stones 7.6 d. No adjacent organ damage. Conclusion Percutaneous nephrolithotomy minimally invasive treatment of renal calculi guided by color Doppler ultrasonography is safe, easy to operate, highly effective and has fewer complications. It is worthy of clinical application.