微创经皮肾镜取石术治疗复杂性输尿管上段结石

目的:探讨微创经皮肾穿刺输尿管镜取石术(minPCNL)治疗复杂性输尿管上段结石的优越性及有效性。方法:对接受minPCNL治疗的126例患者资料进行回顾性分析。其中单发输尿管上段结石95例;并患同侧肾结石21例;双侧输尿管上段结石10例。结果:所有患者均行一期穿刺取石,共行142次手术。其中单通道穿刺取石120例,二通道6例。结石清除率95.2%。肾造瘘管平均留置时间5天,平均住院时间8天。2例需要输血,其中1例minPCNL术中输血,1例术后5天并发大出血而改开放手术输血。1例术后3天并发高热,经引流、抗感染治疗1周后治愈。无其他重大并发症。结论:minPCNL治疗复杂性输尿管上段结石安全、可行、疗效确切,与经尿道输尿管镜取石术及传统开放手术相比,解决了重度肾积水输尿管迂曲或结石下方输尿管炎症狭窄导致经尿道输尿管镜无法到达结石的难题,同时亦避免了开放手术创伤大、并发症多的问题。

Treatment of complicated upper ureter calculi on minimally invasive percutaneous nephrolithotomy

Objective:To assess the safety, feasibility and the curative effect of treatment with minimally invasive percutaneous nephrolithotomy(mini-PCNL) in complicated upper ureter calculi.Methods:A restrospective investigation was performed on 126 cases suffering from upper ureter calculi,who were treated with mini-PCNL from February 2002 to February 2005. Of 126 cases, upper ureter calculi was in 95, upper ureter calculi accompanied the same side renal calculi in 21, bilateral ureter calculi in 10.Results:Of 126 cases, 95.2% stone-free rate was achieved using one-stage mini-PCNL.They were treated by 142 mini-PCNL,single tract was in 120 renal units,two tracts in 6 .Average nephrostomy tube stay was 5 days,average hospitalization stay was 8 days.Blood transfution was performed in 1 patient,high fever in 1 patient postoperative 3 days,who was cured conservativelly.Only one case suffered from massive hemorrhage postoperative 5 days ,who was cured by operation, no major complications were noted in the other patients.Conclusions:Minimally invasive percutaneous nephrolithotomy is safe and effective in treating upper ureter calculi.Compared to open surgery and tranurethra ureteroscopy,it resolved some difficulties like ureter circuity or ureter stricture below ureter stones which can not be reached by caused by ureteroscopy,and avoided the matter of surgery due to local inflammation conglutination.