泌尿系统结石3218例综合观察

目的探讨治疗泌尿系结石的最佳方案。方法对3218例泌尿系结石患者的临床分类和治疗方法作回顾性分析。本组单纯性肾结石1365例，复杂性肾结石651例，输尿管结石Ⅰ类558例，Ⅱ类452例，Ⅲ类192例。结果本组手术取石1164例，行ESWL治疗1923例，行输尿管镜直视下碎石131例。复杂性肾结石手术组残余结石57例（8.8％），行肾切除12例（1．8％）。ESWL组3个月排石率为81．6％，转手术率为18．4％，切肾率为0％。输尿管镜下气压弹道碎石效果不佳改行手术取石8例（61％）。结论ESWL、输尿管镜直视下碎石、术中应用气压弹道式碎石或两种以上方法联合应用治疗泌尿系结石可减轻患者痛苦或降低手术难度。开放性手术放置内引流可减少术后并发症。ESWL治疗后应积极处理石街、控制感染和最大限度减轻医源性肾功能损害。输尿管镜直视下碎石要有熟练的内腔镜操作技术。

The synthetic therapy of upper urinary calculi (Enclosed 3218 cases report)

Objective To improve the therapeutic effect of upper urinary calculi. Methods The cases of 3218 patients with upper urinary calculi were analyzed retrospectively.1365 patients with pure kidney calculi;651 patients with complexity kidney calculi,558 patients with I class ureteral calculi;452 patients with II class ureteral calculi;192 patients with IIIclass ureteral calculi. Results ESWL(extra-corporeal shock wave lithotripsy)was the first choise for the patients with pure kidney calculi I class ureteral calculi,surgical operation was the choise for the patients with complicacy kidney calculi and II&III class ureteral calculi .1164 patients were carried out lithotomy.1923 patients were used by ESWL,131 patients with II class ureteral calculi in the middle lower segment were performed with ureteroscopy. The group of 57(the rate was 8.8%)cases surgery still remain stones.12(the rate was 1.8%)patients were treated by means of nephrectomy lithotripsy,The group of ESWL eliminated stones rate was 81.6% during the 3 months .The surgery rate of the cases was 18.4% during the ureterascopy lithotripsy.The rate of rephrectomy was 8 (the rate was 6.1%)cases ureteroscopy lithotripsy turn to lithotomy. Conclusion ESWL,Ureteroscopy lithotripsy,ballast lithotripsy were used during operation, or both methods were used to treat the upper urinary calculi. It can decrease suffering of the patients and the difficulty of surgery. It is suggested that double internal stent drainage used during surgery can reduced complication. Controling the imflammation , reducing the medical damage of renal function after ESWL should be paied attention .To do the ureteroscopy lithotripsy,the skill of endoscopyshould be mastered to the operator.