经皮输尿管镜肾穿刺治疗输尿管上段嵌顿性结石127例临床分析

Management of impacted proximal-ureteral calculi with minimally invasive percutaneous nephrolithotomy of 127 eases

目的总结输尿管上段嵌顿性结石的镜下特点并评价微创经皮肾镜技术治疗的疗效。方法微创经皮肾（MPCNL）输尿管镜观察127例输尿管上段嵌顿性结石的特点并用气压弹道碎石或钬激光治疗。结果结石大且形状不规则，并发输尿管息肉或肉芽组织49例，并发输尿管狭窄26例；均同期处理，113例为一期取石，结石清除率100％，平均手术时间60min，术中平均出血25ml，平均住院时间7d，未发生肾动静脉瘘及输尿管穿孔、断裂等严重并发症。随访3～12个月，未见结石及狭窄复发。结论造成大多数输尿管上段结石长期嵌顿的原因为输尿管息肉或肉芽、狭窄；结石大形状不规则。采用微创经皮肾镜技术治疗输尿管上段嵌顿性结石创伤小、结石清除率高、恢复快．效果满意。

Objective To summarize endoscopic features of impacted proximal-ureteral calculi and to assess the safety and efficacy of minimally invasive pereutaneous nephrolithotomy （MPCNL）for impacted proximal-ureteral calculi. Methods A total of 127 patients underwent MPCNL for impacted proximal-ureteral calculi with pneumatic lithotripsy or holmium or YAG laser. Results Endoscopic observation revealed that long-term impacted proximal-ureteral calculi was complicated with ureteral polyps in 49 eases, and ureteral strictures in 26 eases. 113 patients were simultaneously operated successfully in a single session through a single tract. The mean operating time, blood loss and hospital stay were 60 minutes,25ml and 7 days, respectively. No postoperative arteriovenous fistulas, ureteral perforation and ureteral rupture were noted. No recurrence of stones, no ureteral strictures or other complications occurred after a follow-up of 6 months （from 3 to 12 ）. Conclusion The main causes contributing to obstruction in most of long-term impacted proximal-ureteral calculi are ureteral polyps, ureteral strictures and irregularly large calculi. MPCNL is a safe and effective technique with less injury, higher stone-free rate, quicker recovery for impacted proximal-ureteral ealeuli.