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目的探讨与评价经皮肾镜下应用第四代EMS超声气压弹道碎石清石系统治疗复杂性肾结石的安全性与疗效。方法复杂性肾结石136例(单侧107例,双侧29例),腹部平片(KUB)测量结石最长径2.2~6.6 cm。在B超引导下穿刺并扩张建立经皮肾镜操作通道。采用EMS第四代气压弹道联合超声碎石清石系统治疗肾结石,对其手术时间、结石清除率、手术并发症等资料进行分析。结果 136例均一期建立经皮肾通道,手术总的结石取尽率为90.2%,泌尿系梗阻解除率为100%。平均手术时间53 min。术中失血10~300 ml,平均90 ml。单发肾结石取尽率为95%。术后住院时间7~12 d,平均8.2 d。13例残石,6例二期碎石;4例术后1个月行体外冲击波碎石。6例术后短期发热。随访2~10个月,无大出血、感染、肾周积液。结论经皮肾镜应用第四代EMS超声气压弹道碎石清石术治疗肾结石,可提高碎石、清石率,缩短手术时间,减少手术并发症,具有高效、微创、安全等特点,值得临床推广应用。
Objective To evaluate and evaluate the safety and efficacy of percutaneous nephrolithotomy using the fourth generation of EMS pneumatic lithotripsy lithotripsy in the treatment of complex renal calculus. Methods 136 cases of renal stone complex (unilateral 107 cases, bilateral 29 cases), abdominal plain film (KUB) measured longest diameter 2.2 ~ 6.6 cm. Under the guidance of B-ultrasound puncture and expansion of the establishment of percutaneous nephroscopy access. The 4th generation of EMS pneumatic lithotripsy combined with lithotripsy lithotripsy was used to treat kidney stones. The operation time, stone clearance rate and complications were analyzed. Results Percutaneous renal access was established in 136 cases. The total operation rate was 90.2%. Urinary system obstruction was 100%. The average operation time was 53 min. Intraoperative blood loss 10 ~ 300 ml, an average of 90 ml. Single kidney stone exhaustion rate of 95%. Postoperative hospital stay 7 ~ 12 d, an average of 8.2 d. 13 cases of residual stones, 6 cases of second stage gravel; 4 cases of extracorporeal shock wave lithotripsy 1 month after surgery. Six patients had short-term fever. Follow-up 2 to 10 months, no major bleeding, infection, perirephric fluid. Conclusion Percutaneous nephrolithotomy using the fourth generation of EMS pneumatic lithotripsy lithotripsy for the treatment of kidney stones, can increase the gravel, clear stone rate, shorten the operation time and reduce complications, with high efficiency, minimally invasive, safe, Worthy of clinical application.