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目的:探讨以肾中盏为目标肾盏,采用气压弹道联合超声碎石方式治疗鹿角形结石的效果及安全性。方法:取俯卧位,采用气压弹道联合超声碎石的方式,以肾中盏为目标肾盏行经皮肾镜碎石术(percutaneousnephrolithotomy,PCNL)治疗鹿角形结石患者145例184侧,其中不完全性鹿角形结石115例侧,完全性鹿角形结石69例侧。观察结石的排除率及并发症。结果:144例侧行一期单通道碎石(中盏),7例侧行一期双通道碎石(中盏及下盏5例,中盏及上盏2例);2例侧残留肾盏结石未进一步处理,自动出院;31例侧行二期碎石,单通道者29例,其中4例先行ESWL再行PCNL碎石;双通道者2例(中盏及上盏1例,中盏及下盏1例)。151例侧排尽结石,其中完全性鹿角形结石54例侧,不完全性鹿角形结石97例侧,结石清除率82.1%。手术时间120～330min,平均(147±23)min。血红蛋白下降1～4 g/L,平均下降(2.0±0.6)g/L,术中输血22例,术后输血5例;术后肾盂内感染3例,合并肾周感染、单侧分肾功能受损1例。平均住院时间(13.0±3.5)天。结论:以肾中盏为目标肾盏行PCNL治疗鹿角形结石是非常有效和安全的;气压弹道联合超声碎石对鹿角性结石的清除率较高,治疗时间短,并发症少。
OBJECTIVE: To investigate the efficacy and safety of calyx-shaped calyx with the help of pneumatic lithotripsy and ultrasonic lithotripsy in the treatment of calyx. Methods: In prone position, pneumatic lithotripsy and ultrasonic lithotripsy were performed. One hundred and forty-four cases of calcaneal calculi were treated with percutaneous nephrolithotomy (PCNL) 115 cases of antler-shaped stones, 69 cases of complete antler-shaped stones. Observe the exclusion rate and complications of stones. Results: One hundred and forty-four patients underwent one-stage single-channel lithotripsy (middle lamp) and seven patients underwent one-stage double-channel lithotripsy (middle and lower lamps in 5, middle and upper lamps in 2) No further treatment of calculus stones were discharged. 31 cases of secondary lithotripsy and 29 single-channel grafts were obtained. Among them, 4 cases were preceded by ESWL followed by PCNL grafts, 2 cases were double-channel (1 case of middle and upper cup, 1 case of light and the next light). Of the 151 cases, the stones were exhausted side by side, of which 54 cases were complete denticular stones, 97 cases were incomplete denticular stones, and the stone removal rate was 82.1%. The operation time was 120 ~ 330min, with an average of (147 ± 23) min. Hemoglobin decreased by 1 ~ 4 g / L with an average decrease of (2.0 ± 0.6) g / L, blood transfusion in 22 cases and postoperative blood transfusion in 5 cases. Postoperative pelvic infection in 3 cases with perinatal infection and unilateral renal function 1 case of damage. The average hospital stay (13.0 ± 3.5) days. CONCLUSION: PCNL is the most effective and safe treatment for calyx calculi with calyceal middle calyx. The combination of pneumatic ballistic and ultrasonic lithotripsy has a higher clearance rate for antler calculus, shorter treatment time and fewer complications.