EMS第三代碎石清石系統(tǒng)治療復雜性腎結石

摘要：目的 分析瑞士EMS第三代碎石清石系統(tǒng)處理復雜性腎結石的臨床療效。

關鍵詞：腎結石；經(jīng)皮腎穿刺取石術；彈道超聲波碎石清石系統(tǒng)

Treatment of complex renal calculi by the third generation Swiss LithoClast Master

XIAO Ning1，ZENG Ge-wa1，ZHOU Xin1，DENG Zhen-nong1，WANG Dong-hui1，ZHAO Xiao-kun2，ZHAO Hong-qin2

（1.Department of Urology，The second Hospital affiliated to GuangZhou Medical University，Guangzhou 510260，Guangdong，China；2.Department of Urology，The Second Xiangya Hospital of Central South University，Changsha 410011，Hunan，China）

Abstract：Objective Analysis of the efficiency in treatment of complex renal calculi by the third generation Swiss LithoClast Master.Methods The suffering patiente，'s clinical data，which including operation time，blood loss quantity，residual stone rate and postoperative fever rate，were collected from Apr 2013 to Oct 2013 was assessed retrospectively.Results The operation time were 69.8±23.2min，the blood loss quantity were 0.66±0.39g/L，the residual stone rate were 13.2%（5/38），the postoperative fever rate were 2.6%（1/38）. Conclusion The short operation time，low residual stone rate and low postoperative fever rate were found in treatment of complex renal calculi by the third generation Swiss LithoClast Master.

Key words：Renal calculi；Percutaneous nephrolithotripsy；Nephrolithotripsy with pneumatic and ultrasonic power

復雜性腎結石的治療難度大，風險高。2013年4月～10月，廣州醫(yī)科大學附屬第二醫(yī)院采用瑞士EMS第三代碎石清石系統(tǒng)治療復雜性腎結石38例，現(xiàn)將臨床療效報告如下。

1 資料與方法

1.1一般資料

1.2方法

1.2.1主要器械設備 德國Wolf 20.8F經(jīng)皮腎鏡、wolf 8.0/9.8F輸尿管硬鏡、瑞士EMS第三代碎石清石系統(tǒng)、經(jīng)皮腎穿刺筋膜擴張器及10～18F Peel-away，Wolf疊套式金屬擴張器等。

1.2.2 手術步驟 ①全麻后，膀胱截石位，膀胱鏡下患側輸尿管逆行插入4～6F 輸尿管導管，外接生理鹽水灌注腎盂，保留導尿。②取俯臥位，腹部墊高，B超定位取11肋間、12肋下、腋后線與肩胛下線區(qū)域為穿刺點，以17.5G腎穿刺針經(jīng)皮腎穿刺目標盞，拔出針芯，見尿液滴出，穿刺成功。引入斑馬導絲，退出穿刺針，沿導絲以筋膜擴張器和疊套式金屬擴張器依次擴張經(jīng)皮腎通道至21F，留置24F金屬鞘。③置入20. 8Fwolf 腎鏡，采用超聲聯(lián)合氣壓彈道碎石清石，檢查腎盞、腎盂、腎盂輸尿管連接部及上段輸尿管有無結石殘留。術中需用地塞米松5 mg及速尿20mg 各1次，必要時可加用地塞米松5mg 1次。

1.3觀察指標 總結手術一般情況和術后并發(fā)癥，觀察患者年齡分布、結石負荷、失血量（術前與術后血紅蛋白最大濃度差）、手術時間、殘石率和術后發(fā)熱率。

2 結果

3 討論

自從1980年代發(fā)明ESWL后，常用于治療腎結石[1]。但是對于>2cm的腎結石或鹿角型結石，ESWL的治療效果并不顯著，常需要行PCNL治療，常用包括超聲碎石、鈥激光碎石或氣壓彈道碎石。……