超微肾造瘘结合输尿管软镜治疗上尿路结石的临床观察  

Clinical efficacy of ureterscopic holmium laser combined with ultrafine nephrostomy in the treatment of upper urinary calculi

作　　者：付强[1] 张静[2] 宋斌[1] 杨帆[1] 高闫尧 毛天赐[1] 

机构地区：[1]第四军医大学唐都医院泌尿外科,陕西西安710038 [2]第四军医大学唐都医院检验科,陕西西安710038

出　　处：《现代泌尿外科杂志》2017年第3期196-197,200,共3页Journal of Modern Urology

摘　　要：目的探讨超微肾造瘘结合输尿管软镜钬激光处理上尿路结石的临床价值。方法唐都医院输尿管上段结石患者18例,肾结石患者30例;结石直径2.4~4cm,平均直径为(2.35±0.23)cm。所有病例均有不同程度肾积水,术前1~3d先行超微经皮肾造瘘,留置中心静脉套管作为超微肾造瘘引流管,引流并抗感染治疗,经尿道采用F8"铂立"可拆卸输尿管软镜联合钬激光进行碎石。术后常规留置F6双J管4周。术后3d复查腹部平片(KUB)。结果 38例一次顺利置入输尿管导引鞘,10例留置双J管2周后二次软镜碎石成功。一次碎石成功率79.2%(38/48),二次碎石成功率100%。手术时间30~65min平均(40.0±5.5)min。结论超微肾造瘘结合输尿管软镜钬激光处理上尿路结石,对于部分感染性结石,因为术前、术中及术后感染性尿液通过肾造瘘充分引流,明显降低既往输尿管镜术后严重感染的情况,并术中通过超微肾造瘘冲洗,可顺行冲洗结石颗粒,利于术中排石。超微肾造瘘结合输尿管软镜钬激光处理输尿管上段结石安全有效,值得临床推广。Objective To evaluate the clinical efficacy of ultrathin nephrostomy combined with ureteroscopic holmium laser in the treatment of upper urinary calculi. Methods Clinical data of 48 cases were retrospectively analyzed, including 18 cases of upper ureter calculi and 30 cases of kidney stones, stone diameter 2.4-4 cm, average 2.35±0.23 cm. All patients had varying degrees of hydronephrosis. One to 3 days before surgery, ultrafine percutaneous nephrostomy was performed, central venous cannula was indwelt as ultrafine nephrostomy drainage pipe, and then drainage and anti-infection treatment were ad- ministered. Transurethral F8 ＂Platinum legislation＂ removable flexible ureteroscope holmium laser lithotripsy was performed. F6 double J tube was indwelt for 4 weeks after surgery. KUB was checked 3d after surgery. Results Of all cases, 38 had ureteral sheath smoothly inserted, and 10 cases had a second operation 2 weeks after the double J tube indwelling. The success rate was 79.2% （38/48） and 100%0 for one-stage and two-stage operations respectively. The average operation time was 30-65 min, average 40±5.5 min. Conclusion The combination of ultrafine nephrostomy and ureteroscopic holmium laser is safe, minimal invasive and effective in the treatment of ureteral stones, because it can drain adequately, thus reducing serious postoperative infections; meanwhile, stone segments can be washed in the antegrade direction to help remove crushed stones.

关 键 词：超微肾造瘘 上尿路结石 输尿管软镜 

分 类 号：R691.4[医药卫生—泌尿科学]