后腹腔镜治疗肾盂输尿管连接部狭窄合并同侧肾结石的经验总结  

Clinical experience of retroperitoneal laparoscopic pyeloplasty for UPJO with concomitant ipsilateral renal stone removal

作　　者：陈明[1] 高轶[1] 崔心刚[1] 刘玉杉[1] 姚亚成[1] 任吉忠[1] 徐丹枫[1] 

机构地区：[1]第二军医大学附属长征医院泌尿外科,上海200003

出　　处：《微创泌尿外科杂志》2014年第1期24-26,共3页Journal of Minimally Invasive Urology

摘　　要：目的:肾盂输尿管连接部狭窄可导致继发性肾结石。总结后腹腔镜下肾盂成形及同期取石的治疗经验。方法:回顾性分析既往5年内开展的143例离断性后腹腔镜肾盂成形手术,修剪肾盂后18例患者同期接受了肾结石取出术,其中10例使用腹腔镜抓钳取石、7例使用腔镜下生理盐水灌洗取石、1例使用输尿管软镜取石,评估结石的大小、数量等,术后随访观察肾功能恢复情况。结果:完全结石清除率达72%。1例患者术后接受ESWL治疗。16例患者术后肾图检查提示GFR改善,2例患者GFR无改善,但临床症状改善。结论:腹腔镜肾盂成形及同期取石安全有效,单纯使用腹腔镜抓钳及生理盐水灌洗就能达到满意的结石清除率。Objective:Ureteropelvicjunction (UPJ)obstructionandconcomitant renal calculus disease maycoex-ist.Wepresentourexperiencewithsimultaneouslaparoscopicpyeloplastyandpyelolithotomyinsuchpatients.Meth-ods:Eighteen patients underwent retroperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our in-stitution.Aninitial dismemberingofthe UPJ wasfollowedbyremoval ofthecalculi.Stones wereremoved withthe aidoflaparoscopicgrasper,fluidirragationorflexibleureteroscope.Thepyeloplastywassubsequentlyperformedon allcases.Results:Completestoneclearancewaspossiblein13/18patients (72 %).Onepatientunderwentsubsequent extracorporeal shock-wave lithotripsy .Diuretic renography at follow-up revealed i mproved drainage in 16/18 (89 %) patients ;2patientshadanequivocaldrainagepatternbuttheirsymptomsdisappeared.Conclusions:Laparoscopicpy-eloplastywithconcomitantpyeloplastyisfeasibleandeffective.Laparoscopicgrasperandfluidirragationcanachieve satisfactory stone clearance .

关 键 词：腹腔镜 肾盂成形 肾盂切开取石 

分 类 号：R691.4[医药卫生—泌尿科学]