经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄  

Percutaneous nephrolithotom combined with holmium laser urethrotomy for treatment of renal and upper segment of ureter calculi and stricture

作　　者：徐庆康[1] 沈伟华[1] 徐哲丰[1] 陈峰[1] 段跃[1] 于田强[1] 于永涛[1] 

机构地区：[1]武警浙江省总队医院泌尿外科,浙江嘉兴314000

出　　处：《临床泌尿外科杂志》2012年第8期578-580,共3页Journal of Clinical Urology

摘　　要：目的:探讨经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄的安全性及疗效。方法:对31例患者采用标准通道经皮肾镜超声气压弹道碎石联合钬激光内切开治疗。31例患者为医源性输尿管上段狭窄伴结石23例,先天性肾盂输尿管交界处狭窄伴结石8例;并发输尿管上段结石11例,肾结石20例。结果:31例无一例中转开放,平均手术时间(62.6±8.6)min,恢复进食时间(32±6)h,下床活动时间(3.2±1.2)d。合并输尿管结石患者均予结石取净,肾结石患者2例下盏残留8mm结石,结石取净率为93.5%(29/31)。术后并发症4例,并发症发生率12.9%,术后并发出血1例,予超选择肾动脉栓塞止血治愈,感染2例,予敏感抗菌素控制,双J管移位1例,予输尿管下调整位置。术后3～6个月复查,肾积水改善总有效率87.1%(27/31),4例肾积水无明显变化。随访6～36个月,2例出现腰部酸胀、积水加重症状,予逆行输尿管镜下钬激光内切开+球囊扩张后好转,1例反复感染肾积水加重予肾切除。结论:经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄结石清除率高、创伤小、手术安全有效。Objective：To explore the safety and efficacy of percutaneous nephroscope ultrasonic pressure bomb guided lithotripsy combined with holmium laser urethrotomy for treatment of renal and upper segment of ureter calculi and stricture. Methods：Thirty-one cases with ihtrogenic upper ureteral stenosis in 23 cases,congenital uret- eropelvic junction stenosis （ureteropelvie j unction obstruction UPJO） in 8 cases, ureteral calculi in 11 eases, and kid- ney stones in 20 cases. All patients used a standard channel percutaneous nephroscope ultrasonic pressure bomb guided lithotripsy combined with holmium laser urethrotomy for. Results： Patients of 31 cases with no conversion to open operation, the average time were （ 62.6 ± 8.6 ） min, recovery time were （ 32 ± 6） h, and ambulation time were （3.2±1.2） d. To the single channel of gravel, with ureteral calculi patients to net extraction, patients with kidney stones in 2 cases of lower calyceal calculi residual 8ram,and net extraction rate was 93.5 %（29/31）. Postoperative complications were 4 eases, and complication rate was 12.9% including postoperative bleeding in 1 cases, whom underwent the super selective renal artery emLolization for bleeding cured; infection in 2 cases,whom received sen- sitive antibiotics for infection control; double J shift in 1 case . Postoperative 3-6 month, hydronephrosis relieved, and the total effective rate was 87. 1%（27/31）. 4 cases of hydronephrosis showed no change. After 6-36 months follow-up,2 cases of waist soreness, hydrocephalus exacerbation of symptoms received retrograde ureteroscopie holmium laser urethrotomy and balloon dilation. One case of repeated infection of hydronephrosis aggravated to nephrectomy. Conclusions： Percutaneous nephroscope ultrasonic pressure bomb guided lithotripsy combined with holmium laser urethrotomy for treatment of renal and upper segment of ureter stone with stenosis had a high stone-free rate,small trauma,safety and effectiveness.

关 键 词：经皮肾镜 超声碎石 肾盂输尿管交界处狭窄 内镜肾盂切开术 

分 类 号：R693.4[医药卫生—泌尿科学]