一期经皮肾镜碎石取石术治疗双侧上尿路结石

目的一期经皮肾镜碎石术治疗双侧上尿路结石的安全性及临床疗效。方法2004年7月～2008年12月,在X线或超声定位下采用经皮肾镜碎石术治疗双侧上尿路结石35例,其中双肾结石18例,一侧肾结石、一侧输尿管结石10例,双侧输尿管结石7例。截石位膀胱镜或输尿管镜下单侧或双侧输尿管留置输尿管导管,经皮肾镜手术均采用俯卧位,经输尿管导管注射生理盐水人造肾积水,在腋后线和肩胛下线之间第12肋上下区域行肾穿刺造瘘,建立F16～F32皮肾通道,在灌注泵生理盐水持续冲洗下,用输尿管镜或经皮肾镜,配合气压弹道或钬激光将结石粉碎。单个通道不易清石完全的肾多发结石或铸形结石,可以同样方式定位建立第2或第3条通道。结果本组35例70侧上尿路结石,单通道取石49侧,双通道取石18侧,三通道取石3侧。手术时间（单侧PCNL）：20～185min,平均66min。一次手术结石取净率为80%（56/70）。再次手术取石8侧,三期手术取石3侧,3侧肾结石少量残留未再次手术碎石取石。手术后总的结石清除率为91.4%（64/70）,其中输尿管结石24侧结石清除率100%（24/24）,肾结石46侧结石清除率87%（40/46）。无胸腹腔损伤、肠穿孔等周围脏器损伤的并发症。住院时间5～30d。术后随访3～6个月,B超及KUB＋IVP检查,未见结石复发。结论双侧上尿路结石采用经皮肾镜碎石取石治疗,安全、有效;在条件允许和技术成熟的前提下,可以施行一期治疗双侧上尿路结石。

Percutaneous Nephroscopic Lithotripsy for Bilateral Upper Urinary Calculi

Objective To evaluate the efficacy and safety of percutaneous nephroscopic lithotripsy for the treatment of bilateral upper urinary calculi. Methods From July 2004 to December 2008, we performed percutaneous nephroscopic lithotripsy under X-ray or ultrasonic guidance for 35 patients with bilateral upper urinary calculi. Of the 35 patients, bilateral renal calculi were found in 18 patients, unilateral renal and unilateral ureteral calculus in 10, bilateral ureteral calculi in 7. Results In 35 patients （70 sides） , the calculi was removed through a single tract in 49 sides, through double tracts in 18 sides, and through triple tracts in 3 sides. The mean operation time for unilateral PCNL was 66 min （ranged from 20 to 185 rain）. The stone-free rate was 80% （56/70） on one session. A second-look stone removal was needed in 8 laterals, and 3 laterals underwent three times of lithotomy. In three sides, a few residual renal stones were found after the first operation, but no second operation was performed. The final stone-free rate was 91.4% （64/70） in all of the cases, among which the stone-free rate was 100% （24/24） for ureteral stones and was 87% （40/46） for renal stones. In this series, no chest or abdominal injuries, intestinal perforation, or injuries to surrounding organs were detected. The patients were discharged from hospital in 5 to 30 days, and then were followed up for 3 to 6 months. During the follow- up, B-ultrasonography and KUB ＋ IVP found no recurrence of calculi. Conclusions Percutaneous nephrolithotomy is effective and safe for bilateral upper urinary calculi. By skilled urologists in conditioned hospital, simultaneous bilateral percutaneous nephrolitbotomy performed on bilateral upper urinary calculi can shorten the cycle time of treatment and hospitalization.