后腹腔镜治疗肾盂输尿管连接部狭窄合并同侧肾结石的经验总结

Clinical experience of retroperitoneal laparoscopic pyeloplasty for UPJO with concomitant ipsilateral renal stone removal

目的:肾盂输尿管连接部狭窄可导致继发性肾结石。总结后腹腔镜下肾盂成形及同期取石的治疗经验。方法:回顾性分析既往5年内开展的143例离断性后腹腔镜肾盂成形手术,修剪肾盂后18例患者同期接受了肾结石取出术,其中10例使用腹腔镜抓钳取石、7例使用腔镜下生理盐水灌洗取石、1例使用输尿管软镜取石,评估结石的大小、数量等,术后随访观察肾功能恢复情况。结果:完全结石清除率达72%。1例患者术后接受ESWL治疗。16例患者术后肾图检查提示GFR改善,2例患者GFR无改善,但临床症状改善。结论:腹腔镜肾盂成形及同期取石安全有效,单纯使用腹腔镜抓钳及生理盐水灌洗就能达到满意的结石清除率。

Objective:Ureteropelvicjunction (UPJ)obstructionandconcomitant renal calculus disease maycoex-ist.Wepresentourexperiencewithsimultaneouslaparoscopicpyeloplastyandpyelolithotomyinsuchpatients.Meth-ods:Eighteen patients underwent retroperitoneal laparoscopic pyeloplasty and concomitant pyelolithotomy at our in-stitution.Aninitial dismemberingofthe UPJ wasfollowedbyremoval ofthecalculi.Stones wereremoved withthe aidoflaparoscopicgrasper,fluidirragationorflexibleureteroscope.Thepyeloplastywassubsequentlyperformedon allcases.Results:Completestoneclearancewaspossiblein13/18patients (72 %).Onepatientunderwentsubsequent extracorporeal shock-wave lithotripsy .Diuretic renography at follow-up revealed i mproved drainage in 16/18 (89 %) patients ;2patientshadanequivocaldrainagepatternbuttheirsymptomsdisappeared.Conclusions:Laparoscopicpy-eloplastywithconcomitantpyeloplastyisfeasibleandeffective.Laparoscopicgrasperandfluidirragationcanachieve satisfactory stone clearance .