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目的:探讨超声引导下经皮肾镜超声联合气压弹道碎石清石治疗肾结石的方法及疗效。方法:超声定位引导下穿刺扩张建立F24经皮肾镜操作通道,在F20.8肾镜直视下应用瑞士产第三代EMS超声气压弹道碎石清石系统治疗肾结石180例,其中鹿角样结石35例;多发结石105例;铸型结石30例;孤立肾结石12例;海绵肾结石9例;移植肾结石1例。结果:180例肾结石Ⅰ期成功建立通道并碎石清石178例,余2例I期建立通道出血,留置造瘘管行Ⅱ期经皮肾镜碎石清石治愈,其中双通道碎石清石治愈8例,Ⅰ期清净结石160例(89%),结石残留20例,行Ⅱ期经皮肾镜碎石清石治愈7例,辅助ESWL治愈10例,放弃治疗3例。手术时间26~140 min,平均(55±7.5)min,术中失血20~600 ml,平均80 ml,3例输血400 ml,1例术后经皮肾通道间断出血,共输血1 600 ml,术后2周行选择性肾动脉栓塞止血成功,术后发热65例,高热12例,抗炎对症治疗1周体温恢复正常,术后获随访158例,随访时间3~12个月,术前肾功能不全34例,完全恢复正常21例,好转5例,无改善5例,无继发出血及感染,无结石复发。结论:超声引导经皮肾镜超声气压弹道碎石清石术治疗肾结石损伤小、并发症少、安全可靠、疗效确切。
Objective: To explore the method and efficacy of ultrasound-guided percutaneous nephrolithotomy combined with pneumatic lithotripsy in the treatment of kidney stones. Methods: F24 percutaneous nephrolithotomy was established by puncture and expansion guided by ultrasound, and 180 cases of nephrolithiasis were treated with Swiss third generation EMS pneumatic lithotripsy under F20.8 nephrolithotomy. Among them, antler-like 35 cases of stones, 105 cases of multiple stones, 30 cases of cast stones, 12 cases of isolated kidney stones, 9 cases of sponge kidney stones and 1 case of kidney grafts. Results: One hundred and eighty cases of renal stones were successfully established in stage Ⅰ with 178 cases of lithotripsy and more than 2 cases of I-phase hemorrhage. The second stage of percutaneous nephrolithotomy was performed in indwelling fistula. Among them, The stones were cured in 8 cases, stage Ⅰ clean stones in 160 cases (89%), stone remaining in 20 cases, stage Ⅱ percutaneous nephrolithotomy stone cured in 7 cases, assisted ESWL cured in 10 cases, giving up treatment in 3 cases. The operation time was 26 to 140 minutes with an average of (55 ± 7.5) minutes. The blood loss during operation was 20 to 600 ml with an average of 80 ml and 3 transfusions were performed in 400 ml. After 2 weeks of selective renal artery embolization hemostasis was successful, 65 cases of postoperative fever, fever in 12 cases, anti-inflammatory symptomatic treatment of 1 week body temperature returned to normal postoperative follow-up of 158 cases, followed up for 3 to 12 months, preoperative 34 cases of renal insufficiency, completely recovered in 21 cases, improved in 5 cases, no improvement in 5 cases, no secondary bleeding and infection, no recurrence of stones. Conclusion: Ultrasound-guided percutaneous nephrolithotracheal lithotripsy lithotripsy treatment of kidney stones less injury, fewer complications, safe and reliable, the exact effect.