顺行多镜联合治疗移植肾上尿路结石的临床经验和疗效  

Minimally invasive treatment with anterograde multiple endoscopes for upper urinary tract stones in allograft kidney

作　　者：刘宇保 李建兴[1] 胡卫国[1] 肖博[1] 张刚[1] 付猛[1] 苏博兴[1] Liu Yubao;Li Jianxing;Hu Weiguo;Xiao Bo;Zhang Gang;Fu Meng;Su Boxing(Department of Urology,Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院泌尿外科清华大学临床医学院,北京102218

出　　处：《中华泌尿外科杂志》2022年第4期272-278,共7页Chinese Journal of Urology

基　　金：国家重点研发计划资助项目(2017YFB1302801);北京清华长庚医院院内青年基金(12015C1025)。

摘　　要：目的总结顺行多镜联合微创方式治疗移植肾上尿路结石的临床经验和疗效。方法回顾性分析清华长庚医院2018年6月至2020年8月收治的14例移植肾上尿路结石患者的病例资料。男6例,女8例。平均年龄(47.3±11.1)岁。3例合并高尿酸血症,4例合并高血压病和糖尿病。肾移植手术史分别为≥10年3例,3~5年4例,2年3例,1年3例,4个月1例。3例有输尿管软镜碎石术(RIRS)手术史,因输尿管迂曲严重致置鞘或上镜失败而终止手术;2例因结石梗阻积水行输尿管支架管置入术。7例术前血肌酐正常,4例为慢性肾功能不全代偿期,血肌酐91~139μmol/L;3例为慢性肾功能不全失代偿期或肾衰竭期,血肌酐分别为292、544、708μmol/L。术前血红蛋白平均为117.5 g/L。3例为部分鹿角形结石,4例为肾盏或肾盂单发结石,2例为肾盂或肾盏结石合并输尿管上段结石,5例为肾盂或肾盏多发结石。结石大小:1例上盏单发结石0.7 cm,3例下盏结石分别为1.5、1.6、2.0 cm,1例肾盂结石1.5 cm,2例中上盏结石分别为2.8、3.1 cm,2例中下盏结石分别为1.5、3.2 cm,3例中上盏及肾盂结石分别为2.2、2.5、2.6 cm,2例肾盂合并输尿管上段结石,其中肾盂结石分别为1.3 cm和1.7 cm,输尿管结石分别为0.7 cm和0.5 cm。术前尿常规检查示9例有尿路感染,其中5例尿培养阳性,选择敏感药物治疗好转后手术。14例均采用超声引导下建立皮肾通道的顺行多镜联合微创治疗,根据结石大小和分布情况采用单通道或不同大小口径的多通道经皮肾镜取石术(PCNL)相结合,辅以顺行输尿管软镜碎石术(FURS)的联合方式。共7种术式:单一标准通道经皮肾镜碎石术(S-PCNL)2例,结石大小分别为2.2 cm和2.6 cm;单一微通道经皮肾镜碎石术(M-PCNL)2例,结石大小均为1.5 cm;单一针状肾镜碎石术(Needle-perc)1例,结石大小0.7 cm;S-PCNL联合M-PCNL 2例,结石大小分别为2.8 cm和3.1 cm;S-PCNL联合Needle-perc 3例,结石Objective To discuss the clinical experience and efficacy of minimally invasive anterograde multiple endoscopic treatment of upper urinary tract stones in allograft kidney.Methods We retrospectively analyzed 14 patients with upper urinary tract stones in allograft kidney admitted to our hospital from June 2018 to August 2020.8 cases were female and 6 cases were male,with an average age of 47.3±11.1 years.3 patients had hyperuricemia and four had hypertension and diabetes.The history of renal transplantation was over ten years in 3 cases,three to five years in 4 cases,two years in 3 cases,1 year in 3 cases,and 4 months in 1 case.3 patients had a history of RIRS,and the operation was terminated due to severe ureteral tortuosity resulting in failure of sheathing or ureteroscopy.Ureteral stent was performed in 2 cases due to stone obstruction and hydronephrosis.Serum creatinine was normal in 7 patients before operation,and serum creatinine was 91-139μmol/L in 4 patients in the compensatory stage of chronic renal insufficiency.The serum creatinine was 292,544 and 708μmol/L respectively in 3 patients in the decompensated stage of chronic renal insufficiency or renal failure stage.The preoperative average hemoglobin was 117.5g/L.3 cases were partial staghorn calculi,4 cases were single caliceal or renal pelvis calculi,2 cases were renal pelvis or caliceal calculi with upper ureteral calculi,and 5 cases were renal pelvis or renal caliceal calculi with multiple calculi.Stone size were 1 case of single upper caliceal stone of 0.7cm,3 cases of lower caliceal stones of 1.5,1.6 and 2.0cm,1 case of renal pelvic stone of 1.5cm,2 cases of middle and upper caliceal stones of 2.8 and 3.1cm,2 cases of middle and lower caliceal stones of 1.5 and 3.2cm,respectively.3 cases of middle upper caliceal and renal pelvic stones were 2.2,2.5 and 2.6cm.2 cases of renal pelvis with upper ureteral stones were 1.3 and 1.7cm,0.7 and 0.5cm respectively.Preoperative routine urine examination showed that 9 cases had urinary tract infection,among

关 键 词：尿路结石 移植肾上尿路结石 超声引导 经皮肾镜 针状肾镜 顺行多镜联合 

分 类 号：R699[医药卫生—泌尿科学]