后腹腔镜联合电子输尿管软镜同期处理肾盂输尿管狭窄合并肾下盏结石的临床分析  

Combination of retroperitoneoscopy and flexible ureteroscope in the treatment of ureteropelvic junction obstruction with stones in lower renal calyces

作　　者：安旭方 屈卫星[2] 李晶[2] 周建成[2] 邹铁军[2] 程永毅[2] 徐永刚[2] AN Xu-fang;QU Wei-xing;LI Jing;ZHOU Jian-cheng;ZOU Tie-jun;CHENG Yong-yi;XU Yong-gang(Department of Urology,The Second Hospital of Xining City,Xining 810003;Department of Urology,Shaanxi Provincial People's Hospital,Xi'an 701168,China)

机构地区：[1]西宁市第二医院泌尿外科,青海西宁810003 [2]陕西省人民医院泌尿病院,陕西西安710068

出　　处：《现代泌尿外科杂志》2020年第6期521-523,共3页Journal of Modern Urology

摘　　要：目的探讨后腹腔镜联合电子输尿管软镜同期处理肾盂输尿管狭窄合并肾下盏结石的可行性及疗效。方法回顾陕西省人民医院和西宁市第二医院泌尿外科2014年8月至2017年7月肾盂输尿管狭窄合并肾下盏结石31例患者的临床资料。采用全身麻醉,折刀位,建立3个戳孔,游离肾及输尿管上段,剪开肾盂1个小口,从戳卡置入输尿管软镜鞘至肾盂,输尿管软镜结合钬激光先处理肾下盏结石,后常规行后腹腔镜下离断式肾盂成形术。结果所有手术均成功完成,术后均无漏尿、出血、感染等并发症发生,术后6例有结石残留,自行或体外冲击波碎石(ESWL)辅助排除,术后1月拔出双J管,术后3月复查静脉肾盂造影(IVP)均恢复良好。结论腹腔镜联合电子输尿管软镜同期处理肾盂输尿管狭窄合并肾下盏结石疗效确切,值得推广。Objective To investigate the feasibility and efficacy of a combinatory approach of retroperitoneoscopy(RP)and flexible ureteroscope(f-URS)in the treatment of ureteropelvic junction obstruction(UPJO)with stones in lower renal calyces.Methods The clinical data of 31 patients with UPJO and stones in lower renal calyces treated in Shaanxi Provincial People s Hospital and The Second Hospital of Xining City during Aug.2014 and Jul.2017 were retrospectively analyzed.During operation,all patients received general anesthesia and adopted knife position,and 3 trocars were established.The kidney and upper ureter were dissociated,followed by a longitudinal cut in the pelvis.Then an f-URS was put into the renal pelvis through one of the trocars and the stones were fragmented with holmium laser lithotripsy.After the fragmented stones were removed,nephropyeloplasty was performed.Results All operations were successful,and no urine leakage,bleeding or infection occurred.Residual stones were observed in 6 cases,which were removed automatically or after extracorporeal shock wave lithotripsy(ESWL).The double-J tubes were removed 1 month after operation.All patients were cured conformed by intravenous pyelography(IVP)3 months after operation.Conclusion The combination of RP and f-URS is effective in the treatment of UPJO with stones in lower renal calyces,and can be widely applied.The application experience needs to be further accumulated.

关 键 词：肾结石 联合治疗 肾盂成形术 输尿管软镜 腹腔镜 

分 类 号：R699.2[医药卫生—泌尿科学]