经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石(附78例报告)

目的探讨经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石的安全性和有效性。方法 2007年8月～2009年3月,采用经皮肾镜联合输尿管镜一期治疗78例输尿管结石合并肾结石。其中一侧输尿管结石合并另一侧肾结石24例,双侧输尿管结石合并一侧肾结石8例,单侧输尿管结石合并同侧肾结石46例。结果 78例均一期成功碎石。无严重并发症发生。手术时间40～200min(平均105min),术中出血30～400ml(平均90ml),术后住院时间6～10d(平均7d)。结石清除率91.1%(71/78),3例残余结石直径≥0.6cm,体外冲击波碎石治疗,4例残余结石直径0.6cm,口服药物排石。78例均随访3个月,复查彩超无明显结石残留。结论经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石效率高,创伤小,残石率低,并发症少,安全可行。

Percutaneous Nephrolithotomy Combined with Ureteroscopy in One-Stage Treatment of Ureteral Calculi Complicated with Renal Stones: Report of 78 Cases

Objective To discuss the safety and efficiency of percutaneous nephrolithotomy combined with ureteroscopy in the treatment of ureteral calculi complicated with renal stones.Methods Seventy-eight patients with ureteral and renal calculi were treated by percutaneous nephrolithotomy combined with ureteroscopy in our hospital from August 2007 to March 2009.In the patients,unilateral ureteral calculi and unilateral renal stones in the opposite side were found in 24 patients;bilateral ureteral calculi and the unilateral renal stones were in 8;and unilateral ureteral calculi with unilateral renal stones at the same side were found in 46 patients.Results The operations were completed successfully in all the 78 patients without severe complications,and the clearance rate of stones in one stage was 91.1%（71/78）.The mean operation time in the series was 105 min（ranged from 40 to 200 min）,and the blood loss ranged from 30 to 400 ml（mean,90 ml）.The patients were discharged from hospital in a mean of 7 days after the operation（ranged from 6 to 10 days）.Three patients showed residual stones larger than 0.6 cm in diameter and thus received EWSL.Four patients,who had residual calculi smaller than 0.6 cm in diameter,received medication to remove the stones.The 78 patients were followed up for 3 months,during which color ultrasonography showed no more residual stones.Conclusions Percutaneous nephrolithotomy combined with ureteroscopy is effective,less traumatic,and safe for patients with ureteral calculi complicated with renal stones,leading to low rates of residual stones and complications.