第4、5腰椎水平难治性输尿管结石的处理

目的：探讨第4、5腰椎水平难治性输尿管结石的处理方法。方法：采用经皮肾穿刺造瘘联合经尿道输尿管镜气压弹道／钬激光碎石术治疗第4、5腰椎水平难治性输尿管结石患者20例。结果：20例均在B超引导下成功穿刺建立经皮肾通道。留置肾造瘘管（气囊型）于肾盂输尿管连接部下方．一期行经尿道输尿管镜碎石术。手术时间平均48min（30~70min）．清石率为100％．未出现严重并发症。结论：经皮肾穿刺造瘘联合经尿道输尿管镜碎石术治疗第4、5腰椎水平难治性输尿管结石安全、有效。

The Treatment of Refractory Ureteral Calculus on the Level Between the Fourth and Fifth Lumbar Vertebrae

Objective： To explore the application and efficacy of percutaneous nephrostomy and transurethral ureteroscopy in the treatment of refractory ureteral calculus on the level between the fourth and fifth lumbar vertebrae. Methods：The clinical data of 20 cases with refractory ureterai calculus on the level between the fourth and fifth lumbar vertebrae treated by PCN and transurethral ureteroscopic pneumatic or holmium laser lithotripsy were analyzed retrospectively. Results：Percutaneous access was successfully achieved under B type ultrasound guidance in all cases. Nephrostomy tube was set with the aerocyst under ureteropelvic junction and transurethral uretero- scopic pneumatic or holmium laser lithotripsy was used. The average operation time was 48 minutes （from 30 to 70 minutes）, stone-free rate was 100%. No severe complication was noted. Conclusions：Combination of percutaneous＇nephrostomy and transurethral ureteroscopy is very safe and effective in the treatment of refractory ureteral calculus on the level between the fourth and fifth lumbar vertebrae.