微创经皮肾镜联合输尿管软镜治疗嵌顿性输尿管上段结石

Minimally Invasive Percutaneous Nephrolithotomy Combined with Flexible Ureteroscopy for Incarcerate Upper Ureteral Calculi

目的探讨超声引导微创经皮肾镜(MPCNL)联合输尿管软镜治疗嵌顿性输尿管上段结石的效果。方法 2009年6月～2011年5月,对25例嵌顿性输尿管上段结石行MPCNL钬激光碎石取石术,其中8例术中观察到>0.5 cm结石冲入输尿管远端,输尿管软镜从薄壁鞘管置入处理输尿管中下段碎石。结果手术时间50～105 min,平均75 min。结石全部清除(1例输尿管中段残留0.4 cm结石,辅以尿石通药物治疗1个月排净),均未输血或出现其他严重并发症。结论 MPCNL联合输尿管软镜取石术治疗嵌顿性输尿管上段结石具有损伤小、结石清除率高等优点。

Objective To evaluate the feasibility and efficacy of uhrasound-guided minimal invasive percutaneous nephrolithotomy （MPCNL） combined with flexible ureteroscopy for incarcerate upper ureteral calculi. Methods Since June 2009 to May 2011, we carried out MPCNL combined with flexible ureteroscopy with holmium laser. During the procedure, we observed stones bigger than 0.5 cm in diameter was flushed into the proximal end of the ureter in 8 cases, and with flexible ureteroscope, we removed the stones in the middle and lower ureter. Results The mean operation time was 75 rain （ ranged from 50 to 105 rain）. The stones were removed completely in all the patients. In one of the cases, a residual stone （0.4 cm in diameter） was observed in the middle ureter, which was then cured in one month by conservative therapy. No patient received blood transfusion, and no severe complications occurred. Conclusions MPCNL combined with flexible ureteroscopy is effective and minimally invasive for patients with incarcerate upper ureteral calculi. The rate of stone clearance is high with the method.