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目的探讨经皮肾镜下超声碎石联合气压弹道碎石术(PCNL)治疗肾、输尿管上段复杂性结石的临床疗效。方法在B超引导下经皮肾穿刺造瘘,肾镜下应用组合式超声碎石和气压弹道碎石一体机将结石击碎,并同时将碎石块吸出体外。结果116例患者,96例一期取净结石,6例行二期PCNL后取净结石,12例肾盏内小块结石残留,经软性肾镜取石或体外冲击波碎石(ESWL)后治愈,2例肾盏内残留结石未进一步处理。平均手术时间96min,一期结石清除率82.8%,1例因术后活动性出血行超选择性肾动脉栓塞后止血,2例出现明显的冲洗液外渗,经引流后治愈,无其它严重手术并发症。结论肾镜下超声和气压弹道碎石术具有高效、微创和结石清除率高之优点,可作为治疗肾、输尿管上段复杂结石的重要疗法。
Objective To investigate the clinical efficacy of percutaneous nephroscope and lithotripsy (PCNL) in the treatment of complex calculi in the upper ureter and upper ureter. Methods Under the guidance of percutaneous nephrolithotomy with B-ultrasound, combined lithotripsy and pneumatic lithotripsy under the microscope were used to crush the stones and suck the stones at the same time. Results A total of 116 patients, 96 cases of first stage neoplasm, 6 cases of PCNL after the second stage, nephrolithiasis, 12 cases of residual calculus in calyces were cured by soft nephrolithotomy or extracorporeal shock wave lithotripsy (ESWL) , 2 cases of calculus residual stones without further treatment. The average operation time was 96 minutes. The stone clearance rate of the first stage was 82.8%. One case had hyperaelective hemostasis after renal artery embolization because of postoperative active hemorrhage. Two cases showed obvious extravasation of irrigation fluid, which was cured after drainage and had no other serious operation complication. Conclusions Renal ultrasound and pneumatic lithotripsy have the advantages of high efficiency, minimally invasive and high stone clearance rate, which can be used as an important therapy for complex stones in the upper kidney and ureter.