经尿道输尿管镜联合微通道经皮肾镜治疗输尿管上段嵌顿结石

目的：探讨输尿管上段嵌顿结石的治疗和微创治疗的安全性和有效性.方法：2005年2月～2009年6月间利用经尿道输尿管镜碎石术（URSL）联合微通道经皮肾镜取石术（PCNL）治疗输尿管上段嵌顿结石168例,其中并发肾下盏结石者55例,因发热而诊断为脓肾者12例.结果：168例输尿管上段嵌顿结石患者,因为并发输尿管息肉或水肿而结石包裹,结石较硬或严重粘连,URSL后即行微通道PCNL,Ⅰ期手术结石取净率为98.2%（165/168）,手术时间60～110 min,平均85 min,术中未发生输尿管穿孔及输尿管黏膜撕脱、大出血等并发症.住院时间10～15天.结论：对于输尿管上段嵌顿结石,URSL治疗不满意时,可以联合微通道PCNL.此方法具有微创、安全、效率高等特点,可作为上尿路结石微创治疗方法的补充.

Treatment of Incarcerated Upper Ureteral Calculi with Ureterorenoscopic Lithotripsy Plus Micro-channel Percutaneous Nephrolithotomy

Objective：To explore the safety and efficacy of transurethral ureteroscopy combined micro-channel percutaneous nephrolithotomy for upper incarcerated ureteral calculi. Methods： From February 2005 to June 2009, 168 patients with upper incarcerated ureteral calculi underwent Ureterorenoscopic Lithotripsy （URSL） plus microchannel pereutaneous nephrolithotomy （PCNL）. Among the patients, 55 were combined with low calyx calculi, and 12 had fever and thus were diagnosed with pyonephrosis. Results： 168 patients, who suffered upper incarcerated ureteral calculi with package calculi, calculi hard or severe adhesion induced ureteral polyps or edema, underwent micro-channel PCNL immediately after URSL. The calculi clearance rate of stage I operation was 98. 2% （165 out of 168）, and the mean operative time was 85 min （60 to 110 rain）. There were no complications, such as ureteral perforation, ureteral mucosal avulsion and bleeding. The mean hospital stay was 10 to 15 days. Conclusions：When the treatment result of URSL is not satisfactory, URSL plus PCNI. can be used for the treatment of upper incarcerated ureteral calculi because it is minimally invasive, safe, and highly efficient.