重复肾合并上尿路结石腔内泌尿外科治疗方法的探讨  

The intracavitary urinary surgical therapy for patients with duplex kidney and upper urinary tract calculi

作　　者：徐桂彬[1] 李逊[1] 何朝辉[1] 何永忠[1] 

机构地区：[1]广州医学院第一附属医院微创外科中心,510230

出　　处：《实用医学杂志》2007年第8期1187-1189,共3页The Journal of Practical Medicine

摘　　要：目的:探讨重复肾合并上尿路结石的腔内泌尿外科治疗方法。方法:回顾性分析2001年3月至2006年6月我院收治的35例手术治疗的重复肾合并上尿路结石患者的临床资料。结果:应用体外冲击波碎石术(ESWL)治疗5例,输尿管镜取石术(URL)治疗10例,微创经皮肾取石术(MPCNL)治疗20例。ESWL治疗5例中,1个月后结石排净率为80%(4/5),1例发生输尿管石街,采用URL取净结石。URL治疗10例,同时应用输尿管内切开治疗3例,结石完全清除8例,2例患者因输尿管狭窄上镜失败,其中1例改为MPCNL术,手术成功;另1例放置输尿管内支架后行ESWL,术后结石排出。MPCNL治疗20例,结石清除率90%(18/20);2例术后残石患者中,1例应用体外冲击波辅助治疗后结石完全清除,另1例肾下盏残石未予处理。所在患者手术均成功,术中、术后无大出血,无输尿管损伤,无气胸等严重并发症。27例肾积水患者例行B超随访,随访时间1～38个月;结果失访6例,患肾积水有不同程度的改善18例,无改善3例。结论:腔内泌尿外科技术治疗重复肾合并上尿路结石安全、有效。Objective To investigate the intracavitary urinary surgical therapy for the patients with duplex kidney and upper urinary tract calculi. Methods The clinical data on 38 patients with duplex kidney and upper urinary tract calculi who were treated from March 2001 to June 2006 in our hospital were retrospectively analysed. Results Of 35 patients who underwent surgical treatment, 4 were complete renal duplication and 31 were partial renal duplication. The mean diameter of calculi was 21 mm（from 7 mm to 41 mm）. 5 patients were treated by extracorporeal shock wave lithotripsy （ESWL）, 10 by ureteroscopic lithotripsy （URL）, 20 by mini-percutaneous nephrolithotomy （MPCNL）, and only 4 by nephrectomy. The stone clearance rate was 80 % （4/5） one month after ESWL. Of 10 cases treated by URL, the calculi were completed eliminated in 8 patients and the procedure failed in 2 patients due to their ureterostenosis. One of the patients with ureterostenosis was then treated with MPCNL, the other was treated by ESWL after a stent placement inside the ureter. MPCNL was performed on 20 patients and the stone clearance rate was 90% （18/20）. No severe complications such as heavy intraoperative or postoperative blood loss, ureter injury, and pneumothorax occurred. 27 patients with nephrohydrosis were followed up for 1 to 38 months and most of them improved at different extents. Conclusion The current technique of urologic surgery is safe and effective in the management of duplex kidney concomitant with upper urinary tract calculi.

关 键 词：泌尿生殖系统畸形 肾结石 体外冲击波碎石术 输尿管镜取石术 微创经皮肾穿刺取石术 

分 类 号：R699[医药卫生—泌尿科学]