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目的探讨B超引导下全尿路会师贯通技术联合EMS超声气压弹道碎石系统治疗复杂性肾结石的方法、优势。方法复杂性肾结石患者64例,男41例,女23例,平均年龄41(24~64)岁,结石直径1.0~3.5 cm,单发55例,多发9例、鹿角形结石4例、铸型结石11例。左侧29例、右侧30例、双侧5例。其中患肾有手术史2例,合并泌尿系感染26例,肾功能不全8例,其中氮质血症6例、尿毒症2例。均采用B超引导下全尿路会师贯通技术联合超声碎石系统治疗。结果 64例、68侧均一期成功建立24F经皮肾通道,一期碎石61侧,二期碎石3侧,一期碎石中行2通道碎石2侧。双侧同时碎石1例,1例1侧行2通道碎石,平均手术时间103 min。术后平均住院时间6.5 d。一期结石清除率为90.6%(58/64),总结石清除率为93.7%(60/64)。术中无气胸、腹腔脏器损伤等严重并发症发生。术后3~5 d复查B超或KUB,11例有结石残留,结石最大径0.3~1.2 cm。术后辅以体外冲击波碎石治疗3例,≤4 mm结石9例予药物排石等保守治疗。术后随访1~6个月,拔出双J管时间3~10周。术前肾功能不全8例患者,术后1个月复查血肌酐值恢复正常3例,与术前持平3例(SCr水平与术前比较相差小于5 mmol/L),加重2例。58例获随访3~24个月,结石无复发。结论 B超引导下全尿路会师贯通技术联合超声碎石治疗复杂性肾结石效率高、并发症少,是治疗复杂性肾结石理想的治疗方案。
Objective To explore the advantages and disadvantages of B-guided percutaneous urotomy through the combination of EMS and EMS pneumatic lithotripsy in the treatment of complex renal calculi. Methods 64 cases of complicated kidney stones, 41 males and 23 females, mean age 41 (24 to 64) years old, the diameter of stones 1.0 ~ 3.5 cm, single 55 cases, multiple 9 cases, 4 cases of antler calculus, cast Type stones in 11 cases. 29 on the left, 30 on the right, and 5 on both sides. Among them, there were 2 cases of kidney surgery, 26 cases of urinary tract infection, 8 cases of renal insufficiency, 6 cases of azotemia and 2 cases of uremia. Under the guidance of the B-guided all urinary Rouxu Tong technology through ultrasound lithotripsy system. Results 64 cases, 68 sides of one phase successfully established 24F percutaneous renal access, a gravel 61 side, two gravel 3 side, a gravel in 2 channel 2 gravel. Bilateral gravel in 1 case, 1 case of 1-sided 2-channel lithotripsy, the average operation time was 103 min. The average postoperative hospital stay was 6.5 days. The first stage stone clearance rate was 90.6% (58/64), the total stone clearance rate was 93.7% (60/64). No pneumothorax, abdominal organ injury and other serious complications occurred. B-ultrasonography or KUB was performed 3 to 5 days after operation, and residual stones were found in 11 cases. The maximum diameter of stones was 0.3 to 1.2 cm. Postoperative extracorporeal shock wave lithotripsy in 3 cases, ≤ 4 mm stones 9 cases of drug delivery row of stones and other conservative treatment. Follow-up 1 to 6 months after surgery, pull out double J tube time 3 to 10 weeks. Preoperative renal insufficiency in 8 patients, 1 month after the return of serum creatinine value returned to normal in 3 cases, unchanged 3 cases before surgery (SCr levels compared with preoperative difference of less than 5 mmol / L), exacerbation in 2 cases. 58 cases were followed up for 3 to 24 months without recurrence of stones. Conclusion Under the guidance of B-guided ultra-Urethral grafting technique combined with ultrasonic lithotripsy in the treatment of complex nephrolithiasis with high efficiency and few complications, it is an ideal treatment for complex renal calculus.