输尿管镜钬激光碎石术联合经皮肾镜与输尿管软镜治疗输尿管石街的22例临床观察

Ureteroscopic holmium laser lithotripsy combined with percutaneous nephrolithotomy and flexible ureteroscopy in the treatment of ureteral stone street in 22 cases of clinical observation

目的为输尿管石街的临床治疗总结经验。方法回顾性分析我科2020年1月—2021年9月的22例输尿管石街患者的临床资料,患者石街长度2~8 cm,平均长度3.89 cm。上述患者I期行输尿管镜手术(ureteroscopic lithotripsy,URL)将部分结石取出,剩余结石推入肾盂中,并置入输尿管D-J管;其中8例患者Ⅱ期进行经皮肾镜取石术(percutaneous nephrolithotomy,PCNL),14例患者II期行输尿管软镜碎石取石术(flexible ureteroscopic lithotripsy,FURL)将剩余结石取出。结果两种治疗方法的患者均痊愈出院,无一例发生术中及术后严重并发症。其中PCNL组有1例术后感染,软镜组3例出现术后感染,均予对症治疗后痊愈。术后1月复查肾-输尿管-膀胱(kidney-ureter-bladder,KUB)X线摄片或者肾输尿管膀胱CT提示原输尿管石街消失,肾积水均明显改善或消失。结论输尿管镜钬激光碎石术是治疗石街的主要手段之一,但是对于较长的石街,可将结石推入肾盂中解除输尿管梗阻的临床症状,再用经皮肾镜取石或者输尿管软镜钬激光碎石,这同样是一个很好的治疗方法。

Objective To draw lessons for the clinical treatment of ureteral stone street.Methods The clinical data of 22 patients with ureteral stone streets from January 2020 to September 2021 in our department were retrospectively analyzed.The length of the patients'stone streets was 2-8 cm,with a mean length of 3.89 cm.The above patients underwent ureteroscopy in stage I to remove some of the stones,and the remaining stones were pushed into the renal pelvis and placed into ureteral D-J tubes.8 patients underwent percutaneous nephrolithotomy in stage II,and in 14 patients the remaining stones were removed by flexible ureteroscopic lithotripsy in stage II.Results Patients with both treatments were cured and discharged from the hospital.None of them had serious intraoperative complications.There was one case of postoperative infection in the PCNL group.There were 3 postoperative infections in the flexible ureteroscopic lithotripsy group.All infected patients were treated symptomatically and cured.One month after the operation,the KUB and CT of the ureteral bladder showed that the original ureteral stone street disappeared and the hydronephrosis was significantly improved or disappeared.Conclusion Holmium laser lithotripsy with ureteroscopy is one of the main treatments for stone streets,but for longer stone streets,pushing the stone into the renal pelvis to relieve ureteral obstruction and clinical symptoms,followed by PCNL or flexible ureteroscopic lithotripsy,is also a good treatment method.