应用输尿管镜通过经皮肾微造瘘治疗输尿管上段结石114例报告

Effect and safety of mini-percutaneous nephrostomy by ureteroscopy in treatment of upper ureteral stones:114 cases report

目的探讨应用输尿管镜通过经皮肾微造瘘治疗输尿管上段结石的疗效及安全性。方法本组114例,男63例,女51例,年龄24～71岁。输尿管上段结石大小1.2～2.3 cm×0.6～1.3 cm,左侧53例,右侧61例,其中合并同侧肾积水轻度26例、中度67例、重度16例,结石位于第4腰椎以上。麻醉采用全麻或腰硬联合麻醉。体位采用侧卧位57例、俯卧位44例、仰卧位13例。B超引导定位穿刺肾中盏或上盏,建立16F或18F经皮肾通道,采用输尿管镜代替经皮肾镜,应用电子弹道碎石33例,钬激光81例。术后均顺行放置双J管作内支架,2～4周拔除。结果本组114例手术均成功,手术时间20～55 min,术中无穿刺致周围脏器损伤,均未输血。术后复查照片9例残余最大直径<4 mm的结石,114例均于术后6～8 d出院。结论 B超引导下穿刺建立经皮肾微造瘘,应用输尿管镜代替经皮肾镜治疗位于第4腰椎以上的输尿管上段结石是一种行之有效的治疗方法。该法创伤小、恢复快,安全有效,结石取净率高。

Objective To investigate the effect and safety of mini-percutaneous nephrostomy by ureteroscopy in treatment of upper ureteral stones. Patients and Methods A total of 114 patients, 63 men and 51 women with the age ranged from 24 to 71 were involved in our study. The sizes of upper ureteral stones were ranged from 1.2 cm×0.6 cm to 2.3 cm×1.3 cm. 53 cases suffered from left ureteral stones, and 61 cases in the right. In which 26 cases complicated with mild ipsilateral hydronephrosis, 67 cases with moderate hydronephrosis and severe hydronephrosis in 16 cases. The stones were all higher than 4^th lumbar vertebra. All the procedures were performed with the patients under combined spinal epidural anaesthesia or general anesthesia. In which 57 cases were treated in lateral position, 44 cases in prone position and 13 cases in supine position. The needle was inserted into the upper or middle calyces under the guidance of B ultrasound. Then a 16F or 18F work passage was established. Ureteroscopy, instead of nephroscopy, was performed and the observed stone was fragmented by pneumatic lithotripsy （in 36 cases） or lithoclast （in 85 cases）. Double J ureteral stents were placed in all cases and withdrew after 2 to 4 weeks. Results All 114 （100%） procedures were successful. The operation time ranged from 20 to 55rains. There were no adjacent organ injuries due to the punctures and no blood transfusions were needed. Residual stones occurred in 9 cases. The diameter of the biggest residual stone was less than dmm. The hospitalization time ranged from 6 to 8 days. Conclusions By ureteroscopy, instead of nephroscopy, the mini-percutaneous nephrostomy under the guidance of B ultrasound is an ideal method in treatment of upper ureteral stones higher than 4th lumbar vertebra. This method is effective and safe with less invasion, sooner recovery and higher stone-free rate.