经皮肾镜治疗肾结石合并肾盂输尿管连接部狭窄

目的：评价经皮肾镜治疗肾结石合并肾盂输尿管连接部狭窄（UPJO）的疗效。方法：肾结石合并uPJ0患者36例，男22例，女14例，平均51（45～68）岁。单发结石31例，多发结石5例。9例轻度肾积水，25例中度肾积水，2例重度肾积水。经B超、CT、顺行及逆行尿路造影显示结石平均直径2．4（1．2～4．3）cm，UPJO狭窄段平均长度2．0（1．5～3．0）cm；36例均在B超引导下经皮建立肾脏单通道行气压弹道联合超声碎石，并采用自制微小电钩行UPJO狭窄环内切开术。结果：36例肾结石完全清除。33例UPJO狭窄环完全解除，肾积水消失；3例肾积水症状缓解，无进行性增加，仍进行临床随访。全部病例术中术后均无严重并发症发生。36例随访平均24（6～40）个月，经B超、CT、顺行尿路造影检查无肾结石复发，无二次狭窄。结论：采用经皮肾镜单通道一次性治疗肾结石合并UPJO微创、安全、可行，总体疗效满意。

Percutaneous Nephrolithotomy with Pneumatic and Ultrasonic on Treatment of Renal Calculi and Ureteropelvic J unction Obstruction

Objective：To discuss the treatment of renal calculi and Ureteropelvic junction obstruction（UPJO） by percutaneous nephrolithotomy（PCNL）. Methods： A retrospective review of consecutive percutaneous nephrolithotomy in 36 patients between June 2007 and May 2010 were performed. All calculi were fragmented and extracted by pneumatie and ultrasound lithotripter, and using a small laser（made by ourselves）for Ureteropelvic junction obstruction by retrograde. Results： 36 eases renal calculi were cleanuped. All cases of Ureteropelvic junction obstruction are success exept for 3 cases. No major complication occurred intraoperative. The 3 cases continue to review. CT,IVU and B ultrasound examination revealed that the hydrone-phrosis alleviated during the follow-up and no calculi reoccurred. Conclusions： The management of renal stone and Ureteropelvic junction obstruction using pereutaneous nephrolithotomy appears to be efficacious and safe underult rasonic guidance.