顺行输尿管软镜碎石术治疗尿流改道后上尿路结石分析

目的：评价顺行输尿管软镜碎石术治疗各种尿流改道后上尿路结石的临床应用价值、安全性及疗效。方法：2009年1月～2012年2月采用顺行输尿管软镜碎石术治疗尿流改道后上尿路结石患者19例，其中左侧13例，右侧5例，双侧1例；输尿管结石12例，肾结石5例，同时合并肾结石和输尿管结石2例。4例采用C臂X线引导，15例采用B超引导肾造瘘。11例一期行经皮肾造瘘＋顺行输尿管软镜碎石术；8例合并感染及急性梗阻患者一期行经皮肾造瘘，1周后二期行输尿管软镜碎石术。结果：19例患者均取得手术成功，平均手术时间为（61±21）min，平均住院时间为（5．6±3．2）d，术中出血量均〈50ml，术中及术后均未发生严重并发症。17例经历一次碎石程序即完全清除，2例经过2次碎石程序。术后4周复查CT，仅1例显示肾盂残留小片状结石，一期结石清除率达94．7％。平均随访15个月，2例患者复发，显示结石复发率为10．5％（2／19），1例经过ESWL得到成功治疗，另1例再次顺行输尿管软镜碎石治疗成功。结论：顺行输尿管软镜是处理尿流改道后上尿路结石治疗的首选方式，具有安全性高、手术成功率高、结石清除率高、复发率低、并发症少等优点，值得临床推广应用。

Anterograde flexible ureteroscopic lithotripsy in management of upper tract stones after urinary diversion

Objective： To evaluate the clinical value, efficacy and safety of anterograde flexible ureteroscopie lithotripsy in the management of upper urinary tract stones after urinary diversion by a retrospective analysis of 19 cases. Methods： From January 2009 to February 2012, 19 patients with upper urinary calculus after urinary diversion were enrolled in this study. There were 13 cases with left side calculi, 5 cases with right side ones and 1 case with two sides. Percutaneous nephrostomy were guided with ultrasonography in 15 patients and X-ray fluoroscopy in 4 patients. There were 12 cases with ureteral stones, 5 cases with kidney stones and 2 cases with ureteral stone and kidney stone. 11 cases without complications underwent percutaneous nephrostomy and simultaneous anterograde flexible ureteroscopic lithotripsy. Simple nephrostomic drainage was carried out for 8 cases with upper urinary tract infection or acute obstructive and a second time anterograde flexible ureteroscopic lithotripsy was done 1 weeks later. Results：The flexible ureteroscopic lithotripsy procedure was successful in all the cases. The mean operative time was （61±21） rain. The mean hospital stay was （5.6±3.2） days. The average blood loss was less than 50 ml. No severe complications occurred intraoperative and postoperative. 17 patients became stone-free after one procedure and 2 patients required a second session. Only 1 patient demonstrated residual fragments larger than 4 mm in pelvic during the 4 weeks follow-up. The stone-free rate was 94. 7 % （18/19）. The average follow-up was 15 months. Two cases had recurrent calculus after the first procedure and the recurrence rate was 10.5%. 1 case was successfully managed by the extracorporeal shock wave lithotripsy and the other case was successfully managed by the anterograde flexible ureteroseopic lithotripsy again. Conclusions： The anterograde flexible uretero- scopie lithotripsy is the preferred way to deal with the upper urinary stones after urinary diversion. It is safe and effective procedure, with less complication, low recurrence rate, and a high calculus removing rate. The surgical methods is worthy of clinical application.