微创经皮肾镜取石处理输尿管上段嵌顿性结石

Minimally invasive percutaneous nephrolithotomy on the removal of impacted upper ureteral stones

目的分析经皮肾穿刺造瘘顺行输尿管镜下取石术（PCNL）治疗输尿管上段嵌顿性结石的有效性及安全性。方法 67例输尿管上段嵌顿性结石患者,行皮-肾造瘘及顺行输尿管镜下气压弹道碎石术。男42例,女25例,年龄23~58岁,平均44岁。结石直径10~28 mm,平均17 mm。结石位于肾盂输尿管交界至第4腰椎下缘。术前行B超及静脉尿路造影检查,术后行腹部平片及B超检查评定疗效。结果 67例患者经皮肾镜均为Ⅰ期取石,结石清除率100%,平均手术时间56 min（25~84 min）,术中估计出血量平均28 mL,1例出现输尿管穿孔。平均住院时间7 d。术后复查腹部平片及B超,未发现结石残留。结论微创经皮肾镜取石术治疗输尿管上段较大嵌顿性结石安全有效。

Objective To evaluate the safety and efficacy of antegrade percutaneous nephrolithotomy（PCNL） on the removal of impacted upper ureteral calculi.Methods Sixty-seven patients with impacted upper ureteral calculi were treated by antegrade pneumatic ureterolithotripsy through minimally invasive percutaneous nephrostomy（PCNL）.Forty-two male,25 female,Mean patient age was 44 years（23-58）.Mean stone size was 17mm（10-28 mm） in diameter.The calculi were in the upper ureter between the ureteropelvic junction and the lower border of the fourth lumbar vertebra.Ultrasonography and intravenous urography were performed for all patients before surgery.After operation,plain films and ultrasonography were done.Results All the 67（100%） stones were successfully fragmented with the Swiss Lithoclast by an antegrade approach at 1 session.The stone free rate was 100%.The mean operative time was 56 minutes（range 25-84 minutes）,the estimated blood loss volume 28 mL and a double-J stent was inserted.In follow-up,plain films and ultrasonography showed complete clearance in these patients.The only complication was a ureteric perforation in 1 patient.Conclusion Minimally invasive PCNL is an effective and safe option for the treatment of large,impacted upper ureteral calculi.