输尿管软镜治疗孤立肾上尿路结石34例临床观察

目的探讨输尿管软镜治疗孤立肾上尿路结石的疗效及手术技巧。方法 2012年1月至2013年12月对34例孤立肾上尿路结石患者行输尿管软镜碎石术,其中先天性孤立肾2例,对侧肾切除所致孤立肾8例,对侧肾萎缩(无功能肾)24例;萎缩肾有17例既往行开放手术,4例曾有多次体外冲击波碎石史。34例患者中有21例为孤立肾经皮肾镜术后残留结石,23例患者术前留置D-J管1~4周,11例患者术前无D-J管留置。结果手术时间40~125min,30例均一次碎石成功,单次手术碎石总成功率为88.2%(30/34),其中17例患者术后1月复查腹部平片(KUB)未见明显残留结石,13例患者残留结石4mm;3月后再次复查,结石均完全排出;2例患者因术中角度原因未能完全碎石,术后结合ESWL,但仍有残留结石4mm,1例患者行二次输尿管软镜碎石,间隔时间1月,术后1月复查无明显结石残留;1例孤立肾铸性结石先后行3次软镜,每间隔时间1月,术后复查结石完全排出。结论输尿管软镜治疗孤立肾上尿路结石是安全有效的,特别适用于孤立肾经皮肾镜术后残留结石,其结石排净率高、并发症低,可以作为孤立肾上尿路结石,特别是孤立肾经皮肾镜术后残留结石的首选。

Clinical observation of flexible ureteroscopy in the treatment of upper urinary tract calculi of solitary kidney

Objective To explore the effect and surgical techniques of flexible ureteroscopy in the treatment of upper u‐rinary tract calculi of solitary kidney .Methods From Jan .2012 to Dec .2013 ,34 cases of upper urinary tract calculi of soli‐tary kidney underwent flexible ureteroscopy ,of which 2 cases were congenital solitary kidney ,8 were contralateral nephrecto‐my ,and 24 were contralateral renal atrophy .Among the 24 atrophy cases ,17 underwent open operation ,4 had multiple extra‐corporeal shock wave lithotripsy history .Of all patients ,21 had residual stones after percutaneous nephrolithotomy ,and 23 ca‐ses had D‐J catheter indwelt 1-4 weeks before the operation .Results The operation time was 40-125 minutes .As many as 30 cases had stones successfully crushed with one session ,the success rate being 88 .2% （30/34） .Of these patients ,17 showed no residual stones after one month of follow‐up ,and the diameter of 13 patients＇residual stones was smaller than 4 mm .Three months later ,the stones were fully discharged .The operation failed in 2 patients because the vision of the flexible ureteroscope could not touch the stones ,and after extracorporeal shock wave lithotripsy （ESWL） there were still residual stones with diame‐ter larger than 4 mm .One patient had underwent a second surgery with an interval of one month .The other patient received a third surgery .Either of them had residual stones after one month of follow‐up .Conclusions Flexible ureteroscope is safe and effective in the treatment of upper urinary tract calculi of solitary kidney ,especially for patients who have experienced percutaneous nephrolithotomy with residual stones .