双镜联合治疗输尿管畸形合并肾结石3例报道  

A Report of Three Cases of Combined Dual-Scope Treatment for Ureteral Malformations Complicated by Renal Stones

作　　者：孙允冀 张恒[1] 孙晓璐 高玉兰 李丽华[1] 孙茂坤 Sun Yunji;Zhang Heng;Sun Xiaolu;Gao Yulan;Li Lihua;Sun Maokun(Department of Urology,Shandong Provincial Third Hospital Affiliated to Shandong University(Shandong Stone Disease Prevention and Treatment Center),Jinan 250012,China)

机构地区：[1]山东大学附属山东省立第三医院泌尿外科(山东省结石病防治中心),济南250012

出　　处：《微创泌尿外科杂志》2024年第6期404-410,共7页Journal of Minimally Invasive Urology

摘　　要：目的:探讨采用腹腔镜联合胆道镜治疗输尿管畸形合并肾结石的临床效果。方法:2022年1月至2023年1月山东大学附属山东省立第三医院泌尿外科收治3例输尿管畸形合并肾结石患者,其中2例肾盂输尿管连接部梗阻(UPJO)合并肾结石,1例下腔静脉后输尿管合并肾结石,均应用腹腔镜治疗输尿管畸形,采用胆道镜取出肾结石。术前检查评估输尿管狭窄段长度,术中切开肾盂及近端输尿管,胆道镜经肾盂切口进入肾盏内取出肾脏结石,修复重建肾盂输尿管。结果:3例患者手术完成顺利,无术后并发症发生。术后2 d拔除肾周引流管,术后1周拔除导尿管,术后8周拔除D-J管。拔管6个月后复查,3例患者均无肾盂或输尿管近端积水扩张。结论:腹腔镜联合胆道镜治疗输尿管畸形合并肾结石,效率高、安全性可靠,提示可作为该疾病的首选手术方式,但仍需多中心、大样本及长期的随访来验证其远期疗效及安全性。Objective:To evaluate the clinical efficacy of laparoscopic surgery combined with choledochoscopy in the treatment of ureteral malformations complicated by renal stones.Methods:Between January 2022 and January 2023,three patients with ureteral malformations and renal stones were treated at the Department of Urology,Shan⁃dong Provincial Third Hospital Affiliated to Shandong University.Two patients had ureteropelvic junction obstruc⁃tion(UPJO)combined with renal stones,and one patient had a retrocaval ureter with renal stones.Laparoscopic sur⁃gery was used to treat the ureteral malformations,and choledochoscopy was employed for stone removal.Preopera⁃tive evaluations included assessing the length of the ureteral stricture.Intraoperatively,the renal pelvis and proximal ureter were incised,and the choledochoscopy was introduced through the renal pelvis incision to remove renal stones from the renal calyces.The renal pelvis-ureter junction was reconstructed and repaired.Results:All three surgeries were completed successfully without postoperative complications.The perinephric drainage tube was removed on the second postoperative day,the urinary catheter was removed one week postoperatively,and the double-J(D-J)stent was removed eight weeks after surgery.At six months post-removal,follow-up imaging showed no dilation of the re⁃nal pelvis or proximal ureter in any of the patients.Conclusion:Laparoscopic surgery combined with choledochosco⁃py is an efficient and safe treatment for ureteral malformations complicated by renal stones.It could serve as the pre⁃ferred surgical approach for this condition.However,further multicenter,large-sample,and long-term follow-up studies are needed to verify its long-term efficacy and safety.

关 键 词：腹腔镜 胆道镜 肾盂输尿管连接部梗阻 腔静脉后输尿管 诊断 肾输尿管结石 输尿管成形术 

分 类 号：R693.1[医药卫生—泌尿科学] R692.4[医药卫生—外科学]