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目的:探讨经皮肾镜双频双导管超声碎石系统治疗复杂性上尿路结石的疗效及安全性。方法:回顾性分析2012年5月~2015年4月共263例复杂性上尿路结石患者资料,行经皮肾镜下双频双导管超声碎石系统(Cyberwand)治疗。其中男159例,女104例,肾脏鹿角型结石107例,肾脏多发结石89例,肾结石合并输尿管上段结石67例。结果:262例手术成功,1例因游走肾无法建立碎石通道中转开放手术。一期手术结石取净211例,一期结石清除率80.23%(211/263),二期手术结石取净31例,总结石清除率92.02%(242/263),21例残留肾结石,术后ESWL辅助治疗。术后出现脓毒血症3例,加强抗感染后治愈,6例行超选择性肾动脉栓塞治疗控制出血,术中无肾脏穿孔、气胸、肠道损伤等严重并发症。结论:双频双导管碎石系统安全有效,具有碎石取石效率高、灌注液外渗少、肾内压低、细菌毒素吸收少等优点,从而降低了手术并发症,有效提高了手术安全性。
Objective: To investigate the efficacy and safety of percutaneous nephrolithotracheal dual-frequency dual-guided ultrasonic lithotripsy in the treatment of complex upper urinary tract calculi. Methods: A total of 263 patients with complicated upper urinary tract calculi from May 2012 to April 2015 were retrospectively analyzed. The patients underwent percutaneous nephroscope and double-frequency dual-guided ultrasound guided lithotripsy (Cyberwand). There were 159 males and 104 females, 107 deer antler stones, 89 renal calculi and 67 renal calculi with upper ureteral calculi. Results: 262 cases were successfully operated and 1 case was unable to establish gravel channel transfer and open operation because of walkable kidney. A total of 211 cases of stone removed surgery, a stone clearance rate of 80.23% (211/263), two surgical stones removed in 31 cases, the total removal rate of stone was 92.02% (242/263), 21 cases of residual kidney stones After ESWL adjuvant therapy. Postoperative sepsis in 3 cases, to strengthen anti-infection cured, 6 cases of super-selective renal artery embolization to control bleeding, no renal perforation, pneumothorax, intestinal injury and other serious complications. Conclusion: The double-frequency, dual-catheter lithotripsy system is safe and effective. It has the advantages of high efficiency of lithotripsy, less extravasation of perfusate, lower intrarenal pressure and less bacterial toxin absorption, thus reducing the complications of operation and effectively improving the operation safety.