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目的评价体外冲击波碎石(Extracorporeal shockwave lithotripsy,ESWL)术后即刻经皮肾镜取石(Percutaneous nephrolithotripsy,PCNL)治疗完全鹿角形肾结石的安全性及疗效。方法 2007年6月至2014年6月,采用ESWL术后即刻PCNL的方法治疗完全鹿角形肾结石31例,其中孤立肾完全鹿角形结石2例,双肾完全鹿角形结石2例,合并对侧上尿路结石6例。结石最大径4.1~6.7 cm,平均5.3 cm。控制感染及内科疾病后于术晨先将目标盏及目标盏平行盏、分支细长的肾盏内结石行ESWL,而后即刻在麻醉下建立标准经皮肾通道,行经皮肾镜下气压弹道联合超声碎石清石术。结果 31例33侧完全鹿角形肾结石中,除1例双侧完全鹿角形肾结石因经济原因行单侧手术外,其余32侧均成功建立经皮肾脏通道。一期取净结石24侧,二期取净2侧。结石清除率为81.3%(26/32)。27侧为单通道取石,占84.4%(27/32)。一期手术时间80~200 min,平均118 min。术后输血3例,发热(>38.5℃)2例,抗感染治愈,无严重并发症发生。术后住院6~26 d,平均10.5 d。结论 ESWL术后即刻PCNL治疗完全鹿角形肾结石提高了结石清除率,缩短了治疗周期,且无严重副作用,是完全鹿角形肾结石安全、有效的微创手术方法。
Objective To evaluate the safety and efficacy of percutaneous nephrolithotripsy (PCNL) in the treatment of complete antler kidney stones after extracorporeal shockwave lithotripsy (ESWL). Methods From June 2007 to June 2014, 31 patients with completely staghorn kidney stones were treated with PCNL immediately after ESWL. Among them, 2 were complete antler calculus in solitary kidney and 2 were complete antler calculus in both kidneys. Upper urinary tract stones in 6 cases. The largest diameter of 4.1 ~ 6.7 cm, an average of 5.3 cm. Control of infection and medical disease in the morning after the first target and the target light parallel to the lamp, branch slender calyx calculus ESWL, and then immediately under anesthesia to establish a standard percutaneous renal tunnel, percutaneous nephroscopic pneumatic ballistic joint Ultrasound lithotripsy. Results In 31 cases of complete stalactite nephrolithiasis, all the 32 sides were successfully established percutaneous renal channels, except one case of complete bilateral anthronal nephrolithiasis for unilateral surgery due to economic reasons. A net stones 24 side, two take net 2 side. Stone clearance rate was 81.3% (26/32). 27 sides for the single channel stone, accounting for 84.4% (27/32). The first operation time 80 ~ 200 min, an average of 118 min. Three cases of postoperative blood transfusion, fever (> 38.5 ℃) in 2 cases, anti-infection cured, no serious complications. Postoperative hospital stay 6 ~ 26 d, an average of 10.5 d. Conclusions PCNL treatment of complete antler kidney stones after ESWL can improve the stone clearance rate, shorten the treatment cycle and have no serious side effects. It is a safe and effective minimally invasive surgery for complete antler kidney stones.