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目的:探讨B超引导经皮肾镜下气压弹道联合超声碎石术治疗复杂性肾结石的临床疗效。方法:自2012年1月至2015年1月应用该方法治疗复杂性肾结石患者95例,其中,男55例,女40例,平均年龄45岁(23岁-75岁),均行泌尿系彩超、CT及KUB检查,结石直径2-5.5cm,单发结石80例,多发结石15例,单侧78例,两侧结石17例,合并81例肾积水,尿路感染42例,肾功能不全患者11例,合并6例高血压,2型糖尿病7例,冠状动脉粥样硬化性心脏病3例。结果:95例中86例均1期成功建立经皮肤肾脏通道并成功碎石,手术平均时间为:93分钟,术后住院平均时间为:6.5天,1期结石清除率为:90.5%(86/95)。术后1月复查,若证实无结石残留,拔除留置于患侧输尿管的双J管。11例肾功能不全的患者,术后复查血生化肌酐值基本恢复正常的患者为6例,余5例患者,血肌酐较术前明显降低。结论:B超引导经皮肾镜下气压弹道联合超声碎石术治疗复杂性肾结石的临床疗效明显,具有结石清除率高,术中及术后并发症少,创伤小,恢复快等优点。
Objective: To investigate the clinical effect of B-guided percutaneous nephrolithotomy combined with ultrasonic lithotripsy in the treatment of complex renal calculus. Methods: From January 2012 to January 2015, 95 patients with complex nephrolithiasis were treated with this method, including 55 males and 40 females, with an average age of 45 years (23-75 years). Urinary tract Color Doppler ultrasound, CT and KUB examination, stones diameter 2-5.5cm, 80 cases of single stones, multiple stones in 15 cases, 78 cases of unilateral, bilateral calculi in 17 cases, combined 81 cases of hydronephrosis, urinary tract infection in 42 cases, kidney Eleven patients with dysfunction, combined with 6 cases of hypertension, 7 cases of type 2 diabetes, coronary atherosclerotic heart disease in 3 cases. Results: Totally 86 cases in each of the 95 cases were successfully established percutaneous renal access and successful grafting. The mean time for operation was 93 minutes, the average postoperative hospital stay was 6.5 days, and the stone clearance rate in stage 1 was 90.5% (86 / 95). January review after surgery, if confirmed that no residual stones, removed in the ipsilateral ureteral double J tube. Eleven patients with renal insufficiency, postoperative blood creatinine value of the basic return to normal in 6 patients, the remaining 5 patients, serum creatinine was significantly lower than preoperative. Conclusion: The clinical effect of B-guided percutaneous nephrolithotomy combined with ultrasonic lithotripsy in the treatment of complicated renal calluses is obvious. It has the advantages of high rate of stone removal, less intraoperative and postoperative complications, less trauma and faster recovery.