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目的:探讨球囊扩张经皮肾镜超声联合气压弹道碎石术(PCNL)治疗复杂性肾结石的疗效和安全性。方法:回顾性分析2011年1月~2013年5月65例采用球囊扩张PCNL治疗的复杂性肾结石患者的临床资料,对其手术时间、结石取净率和手术并发症等资料进行分析。结果:61例患者顺利完成Ⅰ期球囊扩张PCNL,手术时间35~86min,平均62min,结石取净率为93.8%(61/65);3例患者因肾镜无法到达残石肾盏而终止手术,1例患者因术中出血影响视野而终止手术,均于Ⅰ期手术后6d在局麻下行Ⅱ期经皮电子膀胱软镜碎石取石术,残石取净率为100%(4/4)。随访1~29个月,其中1例鹿角形肾结石合并脊柱侧弯的老年患者因术后继发出血行超选择性肾动脉栓塞术,1例感染性肾结石合并糖尿病的老年患者因术后感染性休克行抗休克治疗,其余63例均无继发性出血、严重感染等并发症。结论:球囊扩张PCNL治疗复杂性肾结石具有手术时间短、结石取净率高、感染率低等优点,是一种高效治疗复杂性肾结石的微创技术。
Objective: To investigate the efficacy and safety of balloon dilatation percutaneous nephrolithotomy combined with pneumatic lithotripsy (PCNL) in the treatment of complex renal calculus. Methods: The clinical data of 65 patients with complicated nephrolithotomy underwent balloon dilatation of PCNL from January 2011 to May 2013 were retrospectively analyzed. The operation time, the rate of stone removal and the complication of operation were analyzed. Results: Sixty-one patients successfully completed stage Ⅰ balloon-dilatation PCNL. The operation time ranged from 35 to 86 minutes (average 62 minutes), and the stone removal rate was 93.8% (61/65). Three patients were terminated by nephrolithoterrectomy Surgery, 1 patient due to intraoperative bleeding affect the visual field and the termination of surgery, were 6 days after the first phase of surgery in the local anesthesia underwent Ⅱ percutaneous cystoscopic soft lithotripsy, residual stone removal rate was 100% (4 / 4). The patients were followed up for 1 to 29 months. One of the elderly patients with antler nephrolithiasis and scoliosis suffered from secondary hemorrhage due to postoperative hemorrhage and superselective renal artery embolization. One patient with infectious kidney stones and diabetes mellitus suffered from postoperative infection Sex shock line anti-shock treatment, the remaining 63 cases were no secondary bleeding, severe infection and other complications. Conclusions: The balloon-expanded PCNL is a minimally invasive technique to efficiently treat complicated renal calculi with the advantages of short operation time, high stone removal rate and low infection rate.