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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输尿管上段结石的临床疗效。方法复杂性输尿管上段结石患者68例,男36例,女32例,平均年龄42岁(19岁～70岁)。均行B超、CT检查,KUB+IVU检查28例,逆行肾盂造影检查9例。结石直径1.0～4.3cm。单发62例,多发6例。左侧29例,右侧27例,双侧12例。合并患侧肾积水65例,泌尿系感染36例,肾功能不全7例,其中氮质血症期4例,尿毒症前期3例。均采用B超引导经皮肾镜下第三代气压弹道超声碎石清石系统治疗并观察分析。结果 68例80侧均1期建立24F经皮肾通道并碎石成功。平均手术时间65min,术后平均住院时间5d,结石清除率为100%。术中无气胸、腹腔脏器损伤等严重并发症发生。术后随访1～3月拔除输尿管内双J管。术前肾功能不全的7例患者,术后1月复查5例血肌酐值恢复正常,46例获随访3～24个月,无结石复发。结论 B超引导穿刺经皮肾镜下气压弹道联合超声碎石输尿管上段结石效率高、并发症少,是治疗复杂性输尿管上段结石的较好方法,特别对ESWL及输尿管镜碎石失败的病例。
Objective To investigate the clinical effect of B-guided percutaneous nephrolithotomy combined with ultrasonic lithotripsy in the treatment of complex upper ureteral calculi. Method Complex 68 patients with upper ureteral calculi, 36 males and 32 females, average age 42 years (19 years to 70 years). All patients underwent ultrasonography, CT examination, KUB + IVU examination in 28 cases and retrograde pyelography in 9 cases. Stone diameter 1.0 ~ 4.3cm. 62 cases of single, multiple in 6 cases. 29 on the left, 27 on the right, and 12 on both sides. 65 patients with hydronephrosis, urinary tract infection in 36 cases, 7 cases of renal insufficiency, including 4 cases of azotemia, uremia in 3 cases. All patients underwent B-guided percutaneous nephrolithotomy for the third generation pneumatic lithotripsy lithotripsy and observation and analysis. Results 68 cases of 80 sides were 1 phase to establish 24F percutaneous renal access and gravel success. The average operation time was 65 minutes, the average postoperative hospital stay was 5 days and the stone clearance rate was 100%. No pneumothorax, abdominal organ injury and other serious complications occurred. Follow-up 1 to 3 months after removal of double J tube ureter. Seven cases of preoperative renal insufficiency, 5 cases of postoperative recanalization serum creatinine returned to normal, 46 cases were followed up for 3 to 24 months, no recurrence of stones. Conclusion B-guided percutaneous transrenal pneumatic lithotripsy combined with ultrasonic lithotripsy of the upper ureteral calculi with high efficiency and less complications, is the treatment of complex upper ureteral calculi is a good method, especially for ESWL and ureteroscopic failure cases.