经皮肾通道多镜联合顺行治疗回肠膀胱术后上尿路结石1例并文献复习  

Multiple endoscopy for the treatment of upper urinary tract calculi following ileal conduit: a case report and literature review

作　　者：王冰[1] 叶剑飞[1] 赵磊[1] 毕海[1] 卢剑[1] 马潞林[1] 

机构地区：[1]北京大学第三医院泌尿外科,北京100191

出　　处：《北京大学学报（医学版）》2017年第4期733-735,共3页Journal of Peking University:Health Sciences

摘　　要：上尿路结石合并感染的情况是泌尿外科较为棘手的急症,而膀胱全切术及尿流改道术后的患者出现上尿路结石合并感染的情况可能会致命。膀胱全切术及尿流改道术后的患者受解剖异常和一般状况较差等因素影响,罹患上尿路结石、尿路感染的风险大大升高,因此上尿路结石合并感染性休克的处理较为棘手,临床上如何优化该类患者的治疗方案值得我们进一步探究。北京大学第三医院泌尿外科收治1例上述患者,治疗效果肯定,现报道如下。Upper urinary tract calculi with infection is a quite difficult acute urologic emergency. And what is more,upper urinary tract obstruction after radical cystectomy following urinary diversion may be fatal in the vulnerable patients with this kind of situation. Postoperative anatomy and other factors affect the upper urinary tract calculi,and urinary tract infection greatly increased the risk. But it is particularly difficult to handle with patients with poor general condition and septic shock treatment,so how to optimize the selection program is worth further studying. A 65-year-old man was admitted to hospital for combining with renal and ureteral calculi after radical cystectomy（Bricker） in March 2017. The patient underwent transurethral resection of bladder tumor in the outer court because of the discovery of bladder tumor one year before,The postoperative pathology was high-grade papillary urothelial carcinoma and he underwent regular irrigation of the bladder. Because of tumor recurrence,he came to Peking University Third Hospital for further treatment in August 2016,and the examination of urinary tract CT indicated bladder cancer; for bilateral multiple renal pelvis and renal calices calculi,he was given laparoscopic radical cystectomy. After four months,due to sudden chill fever,he was hospitalized. After definite diagnosis,antiinflammatory treatment combined with left nephrostomy was given. The two-stage lithotripsy was performed. After expansion of the original left renal fistula to 24 F（1 F = 0. 33 mm）,24 F sheath was inducted into the kidney. We introduced a flexible ureteroscopy into the channel down to the ureteral obstruction,where we found a 1 cm oval black brown stone obstructed. A guide wire was inducted through the stones down to ileal conduit in the right lower quadrant. Through the ureteroscopy,we made ureteral calculi broken into powder,and replaced the residual stones into the renal pelvis. Then we used the nephroscopy for lithotropsy in the pelvis,and finally we introduced a flexibl

关 键 词：尿路结石 肾造口术 经皮 输尿管镜 

分 类 号：R691.4[医药卫生—泌尿科学]