腹腔镜肾盂成形术联合输尿管软镜取石术治疗肾盂输尿管连接部梗阻合并肾脏结石的临床应用

目的:探讨腹腔镜肾盂成形术联合输尿管软镜取石术治疗肾盂输尿管连接部梗阻(ureteropelvic junction obstruc-tion,UPJO)合并肾脏结石的临床疗效。方法:回顾分析2010年1月至2013年6月收治的18例UPJO合并肾脏结石患者的临床资料。其中单发肾盂结石2例,单发下盏结石4例,多发结石12例(结石均位于肾盂与肾下盏);最大单枚结石2.6 cm,平均结石负荷(3.1±0.9)cm(1.0～4.8 cm)。3例患者曾行ESWL失败,18例患者术前均未接受其他UPJO手术治疗。结果:18例均顺利完成手术,无术中大出血、周围脏器损伤等严重并发症发生。手术时间95～190 min,平均(110±23)min,软镜取石时间8～30 min,平均(18.4±6.0)min。18例患者软镜均能完整检视肾盂,无盲区,术后复查KUB,结石取净率100%。拔除双J管后复查肾脏积水,13例明显缩小,3例无明显积水,手术成功率88.9%。结论:腹腔镜肾盂成形术联合输尿管软镜手术安全、有效,是UPJO合并结石的理想治疗方式。

Clinical application of laparoscopic pyeloplasty combined with flexible ureteroscopy in the treatment of ureteropelvic junction obstruction and kidney calculi

Objective：To evaluate the efficacy and safety of the laparoscopic pyeloplasty （LP） combined with flexible ureteros- copy （f-URS） in the treatment of ureteropelvic junction obstruction （UPJO） with renal stones. Methods：The retrospective analysis was made on the clinical data of 18 patients who underwent LP and f-URS for UPJO with renal stones from Jan. 2010 to Jun. 2013.2 cases were solitary stones located at renal pelvis ,4 cases were solitary stones located at lower calyx, other cases had multiple stones which lo- cated at renal pelvis and lower calyx. Largest single calculus was 2.6 cm. Mean stone size was （3.1 _＋ 0.9） cm （ range ： 1.0-4.8 cm）. 3 cases had ESWL with poor efficacy. 18 patients underwent no other UPJO operations. Results：All cases finished operations successful- ly with no severe complications such as hemorrhoea or injury of surrounding organs. The average operation time was （ 110 -＋ 23 ） rain （range ：95-190 min）. The average f-URS time was （18.4 _＋ 6.0） min （range：8-30 min） , and all f-URS inspected the collecting system successfully with no blind area. The postoperative KUB showed no residual stone fragments in all cases. Hydronephrosis in 13 cases was significantly reduced and 3 cases had no hydronephrosis after removal of double J tubes. The success rate reached 88.9%. Conclu- sions：LP combined with f-URS treatment is a very safe, effective and minimally invasive technique. It might be the ideal option for UP- JO with renal stones.