孤立肾上尿路结石30例治疗探讨

目的探讨孤立肾上尿路结石处理方法及疗效,提高治疗的有效性和安全性。方法总结30例孤立肾上尿路结石患者的治疗经验。其中10例采用微通道经皮肾镜气压弹道碎石术(MPCNL),12例采用体外冲击波碎石术(ESWL),5例采用输尿管镜碎石术(URL),2例采用腹腔镜输尿管切开取石术,1例开放手术。对治疗结果与并发症进行总结。结果 10例采用PCNL患者,Ⅰ期结石取净7例,Ⅱ期结石取净2例,1例有结石残留。12例采用ESWL的患者,9例结石全部击碎,4周后7例结石排净,2例残留小结石,3例改微创手术治疗。5例采用URL的患者,5例结石全部击碎,4周后结石均排净,无输尿管石街等严重并发症。2例采用腹腔镜输尿管切开取石术患者,结石均成功取出。1例肾盂切开取石患者,成功取出全部结石。结论孤立肾上尿路结石治疗风险大,处理此类患者较为棘手,但根据患者具体病情,选择合适的治疗方案,仍可获得满意的治疗效果。

Treatment of upper urinary tract calculi in a solitary kidney

Objective To investigate the therapeutic methods and effect of upper urinary tract calculi in a solitary kidney, to improve the effect and safety. Methods We retrospectively investigated the data of 30 patients with upper urinary tract calculi in a solitary kidney. 10 of them were treated with minimally invasive percutaneous nephrolithotripsy（MPCNL） , 12 of them treated with extracorporeal shock wave litho-tripsy（ESWL） , 5 of them are teated with ureterorenoscope lithotripsy （URL）, 2 of them are teated with retroperitoneal laparoscopic ureterolithotomy, 1 of them is teated with pyelolithotomy , and investigate the effect and complication. Results 7 of them were achieved stone - free by one -state MPCNL, 2 of them were achieved stone -free by two -state MPCNL,1 of them have residual stones. 7 of the 12 petients who treated with ESWL achived stone - free after 4 weeks, 2 of them have residual stones, and 3 of them treated with minimally invasive treatment all of the 5 patients treated with URL achived stone - free 4 week after operation , and no severe complactaion. All of the retroperitoneal lap- aroscopic ureterolithotomy were successfulo 1 case treated with pyelolithotomy was successful. Conclusion Treatment of upper urinary tract calculi in a solitary kidney is very difficuty and very dangerous, but if we have make a appropriate scheme according to patient＇s specific condition, we can still get satisfied effect.