经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄18例报告

Percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi

目的探讨经皮肾镜联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄的方法与疗效。方法回顾性分析2008年6月至2011年6月收治18例有肾及输尿管上段开放手术史、术后残留或复发肾结石合并输尿管上段狭窄患者的资料。男8例，女10例。年龄27～48岁。其中合并’肾积水2～4cm者14例，5～6cm者3例，〉6cm者1例。合并结石〈1cm者15例，1～3cm者2例，〉3cm者1例。应用经皮肾镜超声气压弹道碎石取石，联合使用球囊扩张治疗。统计分析结石清除率、肾积水变化情况及并发症，对比手术前后IVU造影及CTU检查结果情况。结果18例均成功建立通道，无中转开放手术病例。术后第3天肾出血1例（6％），予超选择肾动脉栓塞止血成功；双J管位置不佳1例，予内镜下调整。结石完全清除16例（89％），1例。肾下盏残留结石〈5mm未予处理，1例残留肾结石合并感染，反复治疗无效者行脓肾切除术。术后随访6～36个月，平均12个月，肾积水明显减少14例；肾积水无明显变化3例，再狭窄行球囊扩张后好转，术后患者IVU或CTU肾显影改善。结论经皮肾镜超声气压弹道联合球囊扩张是治疗复发性。肾结石合并输尿管上段狭窄安全有效的方法。

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi. Methods From June 2008 to June 2011, 18 ureteral stenosis patients with the history of ureteral open surgery, postoperative residual or recurrent kidney stones were treated. There were 8 males and 10 females with the age of 27 -48 years. Fourteen cases were with hydronephrosis of 2 -4 cm, 3 cases were with hydronephrosis of 5 - 6 cm and 1 case was with hydronephrosis 〉 6 cm. Subsequent stone size 〈 1 cm was found in 15 cases, 1 - 3 cm in 3 cases, 〉 3 cm in 1 case. All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation. The stone clearance rate, hydronephrosis changes, complications and IVP situation before and after surgery were analyzed. Results All the 18 cases were completed surgery successfully. There was 1 （6%） case with renal hemorrhage 3 days after the surgery and controlled with DSA hemostasis. There was 1 case accepted adjusting double-J tube by ureteroscopy. Sixteen （89%） patient＇s stones were completed removed. One case with residual calyceal stones size 〈 5 mm was not further treated. There was 1 case treated with nephrectomy because of renal stone with infection. The patients were followed up for 6 to 36 months. Fourteen cases with hydronephrosis improved significantly ; 3 cases with no significant changes but improved following balloon dilation. All patients achieved significant improvement in imaging study comparing of preoperative and postoperative data. Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and effective treatment option in the treatment of kidney stones with ureteral stenosis.