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目的:探讨PCNL中联合B超引导建立多通道并寻找残余结石治疗鹿角型肾结石的的安全性与有效性。方法:我院于2013年4月~2014年9月采用PCNL中联合B超引导建立多通道并寻找残余结石治疗鹿角型肾结石患者56例,其中男36例,女20例;平均年龄36.5(16~60)岁。全鹿角型结石24例,部分鹿角型结石32例。结石大小(2.0×4.2)~(3.8×6.5)cm,平均(2.5±0.8)cm×(4.8±1.2)cm。术前结合影像学检查结果确定取石最多的通道为第一通道,用钬激光碎石取石;然后后在第一通道持续灌注下,采用B超扫描明确残石位置和(或)建立新通道完成碎石取石。结果:56例手术均顺利完成。单侧取石46例,双侧取石10例。一期共行手术66侧,2侧术后结石残留行二期手术。一期术后结石清除率为96.9%(64/66侧)。本组手术时间70~120min,平均(89±9.6)min。术中出血量50~300ml,平均(145±12.8)ml。术后平均住院时间5d,无术中大出血、无中转开放手术患者。结论:PCNL术中联合B超引导建立多通道和(或)寻找残余结石治疗鹿角型肾结石安全、便捷,能取得满意的一次性取净结石率,值得进一步深入探讨。
OBJECTIVE: To investigate the safety and efficacy of PCNL combined with B-ultrasound in establishing multi-channel and finding residual stones for treatment of antler kidney stones. Methods: From April 2013 to September 2014, 56 patients (56 males and 20 females) were enrolled in our hospital from April 2013 to September 2014 with PCNL combined with B-guided multi-channel and looking for residual stones in treatment of antler nephrolithiasis. The average age was 36.5 16 ~ 60) years old. All antlers type stones in 24 cases, some antlers type stones in 32 cases. The size of stones was (2.0 × 4.2) ~ (3.8 × 6.5) cm, with an average of (2.5 ± 0.8) cm × (4.8 ± 1.2) cm. Preoperative combined with imaging results to determine the most stone access channel for the first channel, with holmium laser lithotripsy stone; and then continued in the first channel perfusion, using B-scan clear the location of residual stones and / or create a new channel to complete Gravel stone. Results: 56 cases were successfully completed. 46 cases of unilateral stone, double stone in 10 cases. A total of 66 operations side surgery, 2 side residual stones after surgery line two. The stone clearance rate after the first operation was 96.9% (64/66 side). The operation time of 70 ~ 120min, the average (89 ± 9.6) min. Intraoperative blood loss of 50 ~ 300ml, an average of (145 ± 12.8) ml. The average postoperative hospital stay 5d, no intraoperative bleeding, no transfer of open surgery patients. Conclusion: It is safe and convenient to establish multi-channel and / or search residual stones for PCNL combined with B-ultrasound in the treatment of antler nephrolithiasis. It is worth further exploration.