经皮肾镜应用于ESWL治疗失败的上尿路结石疗效观察

目的探讨经皮肾镜技术应用于体外冲击波碎石术(ESWL)治疗失败的上尿路结石的疗效和安全性。方法回顾分析本院2009年1月至2012年2月采用经皮肾镜碎石(PCNL)治疗26例32侧ESWL治疗失败的上尿路结石患者的临床资料。结果所有患者均一次性成功建立单通道,通道建立时间6~17 min,平均8.6 min。结石处理时间20~105 min,平均58.6 min。出血量10~30 ml。术中发现游离型结石7侧,其余25侧结石周围均有不同程度炎性息肉包裹,结石与周围管壁粘连,6例结石中心有大量基质成分堆积。术后复查清石率75%(24/32),无临床意义残石率25%(8/32)。结论 ESWL治疗失败的上尿路结石的特点往往由于病程长、体外碎石致管壁黏膜损伤出血及炎症等因素,造成结石周围炎性息肉包裹,包裹的息肉可能嵌入碎石间形成核心再次形成更大结石。经皮肾镜可有效治疗ESWL治疗失败的上尿路结石。

Efficacy of percutaneous nephrolithotomy of upper urinary stones after failed ESWL treatment

Objective To investigate the efficacy and safety of percutaneous nephrolithotomy in patients with upper urinary stones after failed ESWL treatment. Methods Analyzed retrospectively in our hospital between January 2009 and February.2012 by percutaneous nephroscope lithotrispsy （PCNL） treatment of 26 cases with 32 side ESWL treatment failure of the clinical data of patients with urinary stones. Results All patients had successful one - time establishment of single - channel, and the channel establishment time ranged from 3 to 8 min, with the average time of 4.6 min. Calculi dealing time ranged from 20 to 105 min, with the mean time of 58.6 rain. The amount of bleeding ranged from 10 to 30 ml. Isolated calculi were found in 7 cases, and the remaining 25 cases all had calculi wrapped around by varying degrees inflammatory polyps parcel, with some calculi adhering to the ureteral wall. Six cases had a large amount of accumulation of matrix components in the center of calculi. The stone -free rate was 75% （24/32）, and the residual stone rate was 25% （8/32）, which was of no clinical significance. Conclusion Bleeding and inflammation of the ureter wall mucosal are formed after failures of ESWL treatment of upper urinary stones. These damage combined with long time disease duration result in the inflammatory polyps parcel, which in turn forms the core of larger stones. Percutaneous nephrolithotomy is effective in remedying failed ESWL treatment of upper urinary stones.