彩色多普勒超声引导下经皮肾镜取石术（PCNL）治疗复杂性肾结石的临床分析

目的：总结彩色多普勒超声引导下经皮肾镜取石术（percutaneousnephrolithotomy，PCNL）治疗的复杂性肾结石的经验及其安全性、有效性以及常见并发症。方法：回顾性分析我院2011年7月-2012年8月采用彩色多普勒引导下经皮肾镜治疗复杂性肾结石患者56例的临床资料。结果：所有患者均I期建立经皮肾通道，平均手术时间（107．5±27．5）分钟，24例行EMS气压弹道联合超声碎石（1001．0±27．9）分钟，20例行钬激光联合超声碎石（119．4±23．6）分钟，10例行单纯超声碎石（108．2±30．2）分钟，EMS气压弹道联合超声碎石组的手术时间少于钬激光碎石组，差异有统计学意义（P〈0．05，单纯超声碎石组与另外两组比较无统计学意义P〉0．05）。术前肾功能损伤患者术后随访，肾功能明显改善。结石完全清除率91％，结石部分残留率9％。术中均无严重出血，无周边脏器损伤。术后出现迟发出血5例，反复发热4例，均经对症治疗后缓解。结论：彩色多普勒超声引导除了具有普通超声引导的优势外，还可有效避开肾实质大血管损伤，减少术中及术后出血风险。彩色多普勒超声引导下经皮肾镜碎石取石术是一种治疗复杂性肾结石安全、有效的方法。

The Effect of Percutaneous nephrolithotomy in the Treatment of Complicated Renal Calculi under Color Doppler Ultrasound Guidance

Objective： To summarize the treatment experience of color Doppler ultrasound-guided percutaneous nephrolithotomy （PCNL）, and investigate the safety and efficacy and common complication of the surgery. Methods： A retrospective analysis of 56 complex renal calculi cases＇s clinical data in our hospital from July 2011 -2012 August which were treated by color Doppler guided percutaneous nephrolithotomy were made. Results： The procedures of percutaneous nephrolithotomy in 56 cases were performed in 1 stage. The average operation time was （107.5 ± 27.5） minutes, 24 patients were performed ultrasonic lithotripsy combined with pneumatic lithotripsy; 20 patients were performed holmium laser and ultrasound, and 10 patients were performed ultrasonic lithotripsy. The operation time of ultrasonic lithotripsy combined with pneumatic lithotripsy groups was（101.0± 27.9） min, which is significant lower than holmium laser and ultrasound group（119.4± 23.6） min. Stones depletion rate is 91%, No other organ injury and severe blood loss in surgery. 4 cases have severe infection and 5 cases have delayed bleeding after surgery. Conclusion： Percutaneous nephrolithotomy under the guide of color dopplar ultrasound was a safe and effective method to treat complex kidney calculus, it could also effectively avoid renal Macrovascular injury, and reduce the risk of bleeding.