腔镜治疗小于8mm输尿管结石自行排出后的肾积水的效果  

Endoscopic therapy of hydronephrosis after spontaneous passage of ureteral stones less than 8mm

作　　者：祝兴旺[1] 李永智[1] 刘屹立[1] Xing-wang Zhu;Yong-zhi Li;Yi-li Liu(Department of Urology,the Fourth Hospital of China Medical University,Shenyang,Liaoning 110032,China)

机构地区：[1]中国医科大学附属第四医院泌尿外科,沈阳辽宁110032

出　　处：《中国内镜杂志》2018年第8期93-95,共3页China Journal of Endoscopy

摘　　要：目的探讨对于小于8 mm的输尿管结石自行排出后的肾积水的腔镜治疗的意义。方法回顾性分析该院18例小于8 mm的输尿管结石自行排出患者,所有患者排出结石后1周复查输尿管CT提示仍然存在肾积水及肾周渗出样改变,血白细胞及降钙素原高于正常值,并且有临床腰疼症状,所有病例予以行输尿管检查并留置输尿管支架管。结果 18例结石自行排出患者中,输尿管上段结石7例,输尿管下段结石11例;输尿管结石大小4~8 mm;所有患者入院后1周内结石均自行排出,患者排出结石1周后因肾积水均进行了输尿管镜检查并留置输尿管支架管。其中,12例术中发现输尿管狭窄,输尿管狭窄病例予以留置2枚输尿管支架管;6例术中发现输尿管内多发息肉包裹管腔,予以留置1枚输尿管支架管。术后第5天所有病例再次复查输尿管CT均提示肾积水缓解及肾周渗出完全吸收,并且血白细胞及降钙素原恢复正常,临床腰疼症状全部缓解。18例患者均顺利完成手术,术后5~7 d拔除尿管,无腰部不适及发热症状,顺利恢复出院。结论对于小于8 mm的输尿管结石自行排出后仍然存在肾积水,应警惕输尿管梗阻的存在,行输尿管镜检查留置输尿管支架管有利于结石排出后输尿管黏膜损伤或者狭窄的恢复,减少了患者痛苦,缩短住院时间,可以成为临床上的有效治疗手段。Objective To evaluate the significance of endoscopic treatment of hydronephrosis after spontaneous passage of ureteral stones less than 8 mm. Methods Retrospective analyzed the clinical data of 18 cases of ureteral calculi with less than 8 mm. One week after ureteral calculi discharged spontaneously, all the patients underwent CT, still show that hydronephrosis and perirenal exudation, leukocyte and procalcitonin was high, and patients had lumbago. All the patients underwent ureteroscope examination and indwelling ureteral stent. Results In 18 patients, upper ureteral calculi in 7 cases, 11 cases of lower ureteral calculi. Ureteral calculi size was 4~8 mm. The stones were discharged from all patients within 1 weeks after admission. All patients have hydronephrosis after 1 week of stone expulsion, and underwent ureteroscopy. During the operation, ureteral stricture was found in 12 cases, those cases to be retained 1 ~ 2 ureteral stents; ureteral polyp was found in 6 cases, those cases to be retained one ureteral stent. On the 5 th day after the operation, all the cases in CT showed that relief of hydronephrosis and absorption of the perirenal exudation, leukocyte and procalcitonin was normal. All of the 18 patients were operated successfully, all the patients had no lumbago and fever after catheter removal, and recovered successfully. Conclusion If hydronephrosis still exists after self-discharge of ureteral stones less than 8 mm, we should consider the existence of ureteral obstruction. Ureteroscopic examination of ureteral stent can quickly relieve the symptoms of hydronephrosis and lumbago, and it is advantageous to the recovery of ureteral mucosa injury and stricture, reduce the pain of patients and shorten the length of stay, can be an effective clinical therapy.

关 键 词：输尿管镜 输尿管狭窄 肾积水 输尿管结石 

分 类 号：R692.2[医药卫生—泌尿科学] R693.4[医药卫生—外科学]