肾结石术后并发肾盂输尿管交界处闭锁的原因及防治

The cause prevention and cure of atresia at the ureterpelvic junction after nephrolithotomy for renal calculi

目的：探讨复杂性肾结石取石术后并发肾盂输尿管交界处闭锁的原因和防治方法。方法：对7例复杂性肾结石手术取石后并发肾盂输尿管交界处闭锁的患者进行同顾性分析。6例行输尿管和肾下盏吻合术，并应用双J管作内支架引流。1例行患肾切除术。结果：7例患者均经手术治愈，术后恢复良好。随访6～24个月，6例患者行静脉尿路造影均显示重建的上尿路引流通畅，肾盂肾盏积水明显缓解。结论：肾内型肾盂、肾盂狭小而肾盏扩张者，在取石过程中盲目钳夹造成肾盂黏膜广泛损伤、撕裂，甚至完全断裂而缝合修复不良，放置双J管作内支架引流时间过短或未放置而仅作肾造瘘者，易发生本并发症。肾下盏与输尿管吻合术是治疗肾盂输尿管交界处狭窄闭锁的较好方法，而双J管内支架引流是手术成功的关键。

Objective： To evaluate the cause, prevention and cure of atresia at the ureterpelvic junction after nephrolithotomy for complex renal calculi. Methods： Clinical data of 7 cases were retrospectively reviewed. 6 cases underwent ureterocalicostomy and the Double J catheter were used to sustain and drainage. Nephrectomy for 1 cases. Results： 7 cases were treated successfully. 6 cases were followed from 6 to 24 months, a good drainage and the improvement of hydronephrosis were found. Conclusions.. Intrarenal pelvis and narrow pelvis or calyx with obvious dilated calyx, mucosa of pelvis injuried widely without Double-J atheter to sustain and drainage are the cause of atresia at the ureterpelvic junction. Ureterocalicostomy maybe best method for pelvisatresia. The sustain and drainage of the Double-J atheter was the key of the successful operation.