截石位微创经皮肾镜联合逆行输尿管镜治疗上尿路疾病  

Simultaneous mini-percutaneous nephrolithotripsy in supine position and retrograde ureteroscope for management of upper urinary tract diseases

作　　者：周祥福[1] 湛海伦[1] 陆敏华[1] 肖恒军[1] 廖继忠[1] 周琦[1] 

机构地区：[1]中山大学附属第三医院泌尿外科,广州510630

出　　处：《中华腔镜泌尿外科杂志（电子版）》2009年第4期4-6,共3页Chinese Journal of Endourology(Electronic Edition)

摘　　要：目的探讨截石位微创经皮肾镜联合逆行输尿管镜在处理上尿路疾病中的临床应用价值。方法本组23例中，男15例，女8例。年龄21．69岁，平均（45＋13）岁。23例行腹部平片（KUB）＋静脉肾盂造影（IVU）、超声检查或CT检查：20例为肾结石或合并输尿管结石（其中对侧2例），2例为输尿管多发性结石，1例为腹腔镜膀胱癌根治术＋原位回肠膀胱术后双侧输尿管下端狭窄。肾结石最大径为1．2～3．4cm，输尿管结石长径0．8—1．7cm.23例均伴有肾积水，其中轻度积水7例，中度积水14例，重度积水2例。采用截石位并于患侧腰肋部用水袋垫高，同时进行逆行置管或输尿管镜及PCNL手术。结果本组23例手术均成功，无1例出现结肠损伤等严重并发症。20例。肾结石患者中一期取净结石17例，结石取净率达85％。所有输尿管结石均一期处理干净。输尿管下端狭窄者采用顺行与逆行相结合扩张成功并留置8F双J管。结论截石位行微创经皮肾镜术联合逆行输尿管镜术方便术者顺行及逆行操作，术中无需变换体位，利于击碎的结石冲出，患者及术者体位舒适，避免呼吸及循环严重并发症，是处理上尿路结石安全、高效、方便的新方法。Objective To evaluate the clinical value of simultaneous mini-percutaneous nephrolithotripsy in supine position and retrograde ureteroscope for management of upper urinary tract dis- eases. Methods 23 patients （15 males, 8 females） with upper urinary tract diseases were enrolled in the study. The mean age was 45＋13 years（range： 21-69）. All patients were examined by KUB, ultrasound, intra- venous urogram or computed tomography before operation. 20 patients got renal stones and ureteral stones（2 cases on the opposite side）. 2 patients got multiple ureteral stones. 1 patients got ureter stnosis after laparescopic radical cystectomy. Hydronephrosis were observed in 22 kidneys. The supine position was carried out in the operation. The skin was punctured and the work tract was dilated under the guidance of ultrasound. Simultaneously, retrograde ureteroscope was carried out for ureteral stone. Results The successful operation rate was 100%. There was no severe complications. No case required blood transfusion and turned to open operation during the procedure. 20 patients with renal calculi were cleared out by one stage PCNL.The clearance rate was 85%. The double “J” stent was successfully inserted for the patients with ureteral stenosis. Concluaiona Simultaneous MPCNL in supine position and retrograde ureteroscope for management of upper urinary tract disease with is a new safe, high efficient and convenient approach. The position is con- venient for antegrade and retrograde operation, and need not to change during the procedure. It is the most comfortable position for patients accepting PCNL and surgeons, and can avoid the severe complications of respiration and circulation.

关 键 词：经皮肾镜取石术 平卧位 截石位 输尿管镜 上尿路疾病 

分 类 号：R699[医药卫生—泌尿科学]