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目的探讨侧卧位B超引导经皮肾镜碎石术(PCNL)治疗体外冲击波碎石(ESWL)失败的输尿管上段结石的疗效及安全性。方法回顾性分析2011年6月～2012年3月我院53例ESWL失败的输尿管上段结石患者的临床资料,均予侧卧位B超引导下PCNL治疗,并评估其疗效及并发症。结果 53例患者均顺利完成手术,其中47例患者结石通过手术1次取净。6例术后残余结石患者经进一步辅助治疗,其中4例排净,2例残留结石。首次结石清除率为88.7%,总结石清除率为96.2%。9例发热超过38℃,1例需输血治疗,1例尿脓毒血症致感染性休克,后经综合治疗后恢复良好。未出现动脉性大出血、集合系统穿孔、周围脏器损伤等严重并发症。结论侧卧位B超引导下PCNL治疗ESWL失败的输尿管上段结石具有首次清除率高、手术安全可靠等优点,可作为ESWL失败的输尿管上段结石的一种有效治疗方法。
Objective To investigate the efficacy and safety of lateral ultrasonography guided percutaneous nephrolithotomy (PCNL) in the treatment of upper ureteral calculi with extracorporeal shock wave lithotripsy (ESWL) failure. Methods The clinical data of 53 patients with upper ureteral calculi who failed ESWL in our hospital from June 2011 to March 2012 were retrospectively analyzed. All patients underwent B-ultrasound guided PCNL. The curative effect and complications were evaluated. Results All the 53 patients successfully completed the operation. Of the 47 patients, the stones were removed once by surgery. Six patients with residual calculus after surgery were further adjuvant therapy, of which 4 cases were excluded, 2 cases of residual stones. The first stone clearance rate was 88.7%, the total stone clearance rate was 96.2%. 9 cases of fever over 38 ° C, 1 case of blood transfusion, 1 case of sepsis-induced septic shock, after a comprehensive treatment recovered well. No major arterial hemorrhage, collection system perforation, organ damage and other serious complications. Conclusions The upper ureteral calculi failed by PCNL in the treatment of ESWL under the guidance of lateral position B ultrasound has the advantages of high initial clearance and safe operation. It can be used as an effective treatment for upper ureteral calculi with failed ESWL.