多镜联合同期治疗双侧上尿路结石疗效观察

The effect of multiple endoscopic treatment of bilateral upper urinary tract stones

摘要:

目的 探讨多镜联合同期治疗双侧上尿路结石的方法及疗效。方法 42例患者选用连续硬脊膜外阻滞麻醉，麻醉生效后，取截石位，输尿管结石及小于等于2 cm肾结石联合输尿管硬镜及输尿管软镜行碎石取石术，大于2 cm肾结石，在直视下患侧输尿管置F6输尿管导管，改俯卧位，在B超或C臂机引导下用穿刺针穿刺并扩张，留置F24外鞘后，联合肾镜及膀胱软镜行碎石取石术。碎石完成后，留置F18硅胶肾造瘘管及输尿管支架管，术后常规抗感染治疗3～5 d；根据术后腹部平片情况，5 d后拔除肾造瘘管或再次取石，1～2个月后拔除输尿管内双J管。结果 42例手术只有双肾结石组1例有结石残留，余均一期碎石成功，无改开放手术者，手术时间：50～180 min，平均105 min；术中出血量80～500 mL，平均100 mL。单纯输尿管镜手术在手术次日拔除尿管下床活动，经皮肾镜手术在术后1～3 d拔除尿管后下床活动，4～5 d拔肾造瘘管，术后住院时间3～12 d，平均7.6 d，术后1～2个月拔除输尿管内双J管。术后随访3～48个月，所有患者情况良好，无继发出血等并发症。结论 多镜联合治疗双侧上尿路结石具有清石率高、创伤小、并发症少等优点，值得推广。

Abstract:

【Objective】 To investigate the effect of multiple endoscopic on bilateral upper urinary tract stones .【Methods】 Forty-two patients, male 24，female 18, aged 25-72, were treated .They were 7patients with left kidney and right ureteral stone,5 left kidney and two sides ureteral stone ,6 right kidney and two sides ureteral stone,7 right kidney and flee ureteral stone ,12 two sides ureteral stone ,and 5 two sides kidney stone.Ureteral stones and simple kidney stones surgery underwent ureteroscopic and flexible ureteroscope. Complex kidney stones surgery was carried out under nephrolithotomy and bladder soft lenses. After gravel,leaved double J tube in the ureter,treated 3~5d anti-infection,and removed double J tube after 1or 2 month.【Results】 Forty-one were technically successful in the forty-two patients. The mean operative time was 50-180min and the blood loss in the operation was 80-500ml. No postoperative complication occurred. Neither local recurrence nor metastasis was observed during a follow up of 3-48 month.【Conclusion】 The treatment with multiple endoscopic is a powerful, effective, and safe treatment modality for bilateral upper urinary tract stones.