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目的探讨B超引导单通道经皮肾镜气压弹道联合超声碎石术治疗肾及输尿管上段结石的可行性和安全性。方法对本组258例(271侧)采用经皮肾镜气压弹道联合超声碎石清石系统(EMS III)治疗肾及输尿管上段结石的临床资料进行分析,对一期治疗效果及手术并发症进行总结。结果 271侧全部经单通道取石,手术时间30~180 min。一期单侧结石清除率84.9%(230/271),肾结石(包括肾合并输尿管上段结石)一期清除率79.8%(154/193)。39例残余结石二期结石清除率92.3%(36/39)。输尿管上段结石一期单侧结石清除率97.4%(76/78)。无肾切除、血气胸及感染性休克并发症,迟发性出血行超选择性肾动脉栓塞2例,结肠损伤1例,中转开放2例。结论单通道经皮肾镜气压弹道联合超声碎石术治疗肾及输尿管上段结石具有手术时间短、创伤小、一期治愈率高及可经通道再次手术的优点,操作安全,疗效可靠。
Objective To investigate the feasibility and safety of B-guided single-channel percutaneous nephrolithotomy combined with ultrasonic lithotripsy in the treatment of upper ureteral calculi. Methods The clinical data of 258 cases (271 sides) treated with percutaneous nephrolithotomy combined with ultrasonic lithotripsy (EMS III) in the treatment of upper ureter and upper ureteral calculi were analyzed, and the results of the first-stage treatment and surgical complications were summarized . The results of 271 side all single stone, operation time 30 ~ 180 min. The first stage of unilateral stone clearance rate was 84.9% (230/271), the first stage of kidney stones (including kidney and ureteral calculi) clearance rate of 79.8% (154/193). 39 cases of residual stones secondary stone clearance rate of 92.3% (36/39). Ureteral calculi in the first stage of unilateral stone clearance rate of 97.4% (76/78). No nephrectomy, pneumothorax and septic shock complications, delayed hemorrhage were performed in 2 cases of superselective renal artery embolization, colonic injury in 1 case, 2 cases of transit open. Conclusion The single-channel percutaneous nephroscope pneumatic lithotripsy combined with ultrasonic lithotripsy for the treatment of upper ureter and upper ureteral calculi has the advantages of short operation time, small trauma, high cure rate and reoperation via channel, safe operation and reliable curative effect.