超声引导下微创经皮肾镜治疗上尿路结石152例临床分析

Clinical analyses of color doppler ultrasound-guided mini-percutaneous nephrolithotomy for the treatment of 152 cases upper urinary stones

关键词:  经皮肾镜  国产EMS  Cyberwand双导管碎石机  碎石术

Key words:  [Key words] 　percutaneous nephrolithotomy  domestic EMS  cyberwand dual probe lithotripter  lithotripsy

摘要:

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。

Abstract:

[Abstract] Objective　To evaluate the efficacy and safety of color Doppler ultrasound-guided percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary stones. Methods　From October 2010 to July 2013, a total of 152 patients with renal calculi suitable for PCNL were treated with domestic Fuhuikang-Ⅳ ultrasonic and pneumatic lithotriptor (CQS-01) and Cyberwand dual probe lithotripter. The data were collected and analyzed with regard to operation time, postoperative stone clearance rate, postoperative hospital stays, adverse events rate. Results　Percutaneous renal access was established successfully in 152 patients. 147 patients were treated with PCNL once, 4 patients were treated with PCNL twice because of blood loss, and 1 patient was converted to open surgery as a result of pneumothorax. The average operative time of 18 patients treated with holmium laser was (46±17) min, that of 85 patients treated with ultrasonic was （65±28） min, that of 22 patients treated with ultrasonic and pneumatic was (72±25) min and that of 27 patients treated with Cyberwand was (60±30) min. The stone free rate of the first stage was 89.2% (125 patients). 17 patients underwent extracorporeal shock wave lithotripsy (ESWL). Small residual stones were found in 10 patients without treatment. Average post operative hospital stay was 7.6 days. There were no serious adverse events such as adjacent viscus injury. Conclusion　Color Doppler ultrasound guided percutaneous nephrolithotomy (PCNL) for the treatment of upper urinary stones is safe and effective.