超声引导微创经皮肾镜治疗输尿管上段结石的应用

目的探讨微创经皮肾镜取石术(MPCNL)治疗输尿管上段结石的方法及效果。方法在超声引导下对21例输尿管上段结石患者行经皮肾穿刺建立碎石微通道,经通道于输尿管镜下行碎石取石术。其中男性12例,女性9例,年龄18～57岁,平均年龄45.6岁。左侧输尿管上段结石11例,右侧10例。8例合并同侧肾脏结石。1例合并输尿管狭窄,肾脏中度积水15例,重度积水6例。结石1.0～3.0 cm大小不等。结果 21例均成功建立经皮肾镜微创通道,一期单通道碎石,手术时间60～150min,20例一期结石完全清除,清除率95.2%,1例结石残留,后自行排出。未出现严重并发症。结论微创PCNL治疗输尿管上段结石或合并肾结石及输尿管上段狭窄安全、有效,具有创伤小,恢复快等优势。同时可以有效清除肾结石,对输尿管上段狭窄可同期行内切开术。

Ultrasound-guided minimally invasive percutaneous nephrolithotomy in the treatment of upper ureteral calculi

Aim To investigate the clinical application value and method of ultrasound-guided minimally invasive percutaneous nephrolithotomy（MPCNL） in the treatment of upper ureteral calculi.Methods Twenty-one patients with upper ureteral calculi received minimally invasive percutaneous renal puncture and ureteroscopic lithotripsy under the guidance of ultrasound.Twelve male,9 female,Mean patient age was 45.6 years（18-57 years）.The calculi located in the left upper ureter were 11 cases,10 in the right.Combined with ipsilateral renal calculus were in 8 cases,one patient associated with ureteral stricture,intermediate hydrops in 9 cases,severe hydrops in 6 cases.Mean stone size was 16 mm（10-30 mm）in diameter.Results All the patients were punctured successfully at one prick and twenty patients with upper ureteral calculi were removed out through single passage in phrase I.Operative duration was 60-150 min.The total stone clearance rate was 95.2%.Residual stone fragment was found in 1 patient,then discharged one week later after pull out D-J tube.No serious complications occurred in the operation.Conclusion Ultrasound-guided minimally invasive percutaneous nephrolithotomy is a safe and effective technique for the treatment of upper ureteral calculi or associated with ipsilateral renal calculus or ureteral stricture with the advantages of little trauma and rapid recovery.Meanwhile,ipsilateral renal calculus and ureteral stricture can also be treated effectively.