微创经皮肾镜碎石后输尿管残留结石的门诊处理

Outpatient Treatment for Residual Ureteral Calculi after Minimally Invasive Percutaneous Nephrolithotomy

目的探讨微创经皮肾镜碎石术(min im ally invasive percutaneous nephrolithotomy,MPCNL)术后输尿管残留结石的门诊处理效果。方法直径<10 mm输尿管残留结石,出院等待观察;直径≥10 mm输尿管残留结石或输尿管石街,门诊体外冲击波碎石术(extracorporeal shock wave lithotripsy,ESWL)治疗;经等待观察或ESWL治疗失败或仍有残留结石的患者,门诊局麻下行输尿管镜取石或碎石术。结果43例结石直径<10 mm中,31例在等待观察期间自行排出结石,3例在拔双J管时带出结石,9例局麻下采用输尿管镜取出结石。24例结石直径≥10 mm中,18例ESWL碎石成功,4例局麻下采用输尿管镜取石,2例采用输尿管镜气压弹道碎石术,取净残留结石。本组未见严重血尿、发热、输尿管穿孔、肾绞痛等较重并发症。结论根据患者病情门诊采取适当的措施,处理MPCNL术后输尿管残留结石有效、安全。

Objective To explore the efficacy of outpatient treatment for residual ureteral calculi after minimally invasive percutaneous nephrolithotomy（MPCNL）. Methods The treatments were conducted in an outpatient setting. The patients with residual ureteral calculi （ 〈 10 mm in diameter） were treated by outpatient observation; the patients with residual ureteral calculi（ ≥10 mm in diameter） or ureteral steinstrasse were treated by extracorporeal shock wave lithotripsy （ESWL） ; the patients following the failure of outpatient observation or ESWL were performed by ureteroscopic lithotripsy under local anesthesia. Results Among 43 cases of residual ureteral calculi（ 〈 10 mm in diameter） , stones were discharged spontaneously during observation in 31 cases, stones were taken out when double J tubes were removed in 3 cases, stones were removed under ureteroscope in 9 cases. Among 24 cases of residual ureteral calculi（ ≥ 10 mm in diameter） , stones were cleared by ESWL, ureteroscopic lithotripsy under local anesthesia, and ureteroscopic pneumatic lithotripsy in 18, 4, 2 cases, respectively. No complications such as severe hematuria, pyrexia, ureter perforation, renal colic occurred. Conclusions Appropriate procedures taken according to patient＇ s condition, outpatient treatment for ureteral residual calculi after MPCNL is safe and effective.