逆行输尿管镜碎石辅助顺行经皮肾镜取石术治疗复杂性输尿管上段结石  

Retrograde ureteroscopy fithotomy assisted antegrade percutaneous nephrolithotomy for complex upper ureteral calculi

作　　者：许可慰[1] 张彩霞[1] 黄健[1] 韩金利[1] 林天歆[1] 黄海[1] 江春[1] 刘皓[1] 

机构地区：[1]中山大学孙逸仙纪念医院泌尿外科,广州510120

出　　处：《中国医师进修杂志》2012年第11期22-24,共3页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨斜仰卧．截石体位下逆行输尿管镜碎石（URSL）辅助顺行经皮肾镜取石术（PCNL）治疗复杂性输尿管上段结石的方法与疗效。方法2007年3月至2010年12月对95例复杂性输尿管上段结石患者施行了逆行URSL辅助顺行PCNL。输尿管结石大小12mm×6mm-38mm×15mm，合并肾结石24例。患者采用斜仰卧．截石体位。先施行逆行URSL，当结石碎块上移接近肾盂水平时，则在B超引导下建立16-22F的PCNL工作通道。从PCNL通道顺行置入输尿管镜，行碎石取石术。取石满意后，留置6-7F双J管。结果93例患者成功完成斜仰卧．截石体位下逆行URSL辅助顺行PCNL。2例因曾行开放性手术，输尿管上段扭曲明显，中转为开放性手术。手术时间（42．7±14．9）min；估计出血量（34．5±26．1）ml。术中输尿管结石均完全清除，合并肾结石者肾结石清除率95．8％（23／24）。无术中及术后主要并发症。结论斜仰卧．截石体位下逆行URSL辅助顺行PCNL治疗复杂性输尿管上段结石安全可行，避免了术中体位变换带来的不便；并发症少，手术效果良好；尤其适用于较大结石、阴性结石、合并肾结石以及输尿管结石容易上移的患者。Objective To assess the safety and efi%acy of retrograde ureteroscopy lithotomy （URSL）assisted antegrade percutaneous nephrolithotomy （PCNL） for complex upper ureteral calculi in semisupine-lithotomy position. Methods From March 2007 to December 2010,a total of 95 patients with complex upper ureteral calculi underwent retrograde URSL assisted antegrade PCNL in semisupine-lithotomy position. Ureteral calculi size was 12 mm × 6 mm to 38 mm × 15 mm, 24 cases combined with renal calculus. Firstly retrograde URSL was performed, once the stone fragments moved up to renal pelvis, a 16-22 F PCNL working channel was established under the ultrasound guidance through which lithotripsy was performed using an ureteroscope. Finally a 6-7 F double-J tube was indwelled. Results Operations were successfully completed in 93 patients. However,in it 2 patients were converted to open surgery because of significant ureteral distortion due to previous open surgery. Operative time was （42.7 ± 14.9 ） min; estimated blood loss was （34.5 ± 26.1 ） ml. The ureteral calculi clearance rate was 100.0%,and renal calculus clearance rate in those combined with renal calculus was 95.8% （23/24）. There were no major intraoperative and postoperative complications excepted early urinary leakage in 2 cases and fever ≥39℃ in 3 cases. Conclusions Retrograde URSL assisted antegrade PCNL in semisupine-lithotomy position is safe and feasible for complex upper ureteral calculi,especially non-opaque calculi, combined with renal calculus,easily ascending ureteral calculi and large calculi burden which has low calculi clearance rate after URSL. The outcomes are encouraging with fewer complications. It also avoids intraoperative change of patient＇s position.

关 键 词：输尿管结石 输尿管镜 肾造口术 经皮 斜仰卧-截石体位 

分 类 号：R699[医药卫生—泌尿科学]