局麻下急诊输尿管镜碎(取)石术治疗孤立肾输尿管下段结石

The emergency treatment of stone in lower ureter in solitary kidney patients using ureteroscope lithoclasty(stone removed) under local anesthesia

目的探讨局麻下急诊经尿道输尿管镜碎(取)石术治疗孤立肾输尿管下段结石的安全性和效果。方法 2007年2月至2009年11月,4例患者经超声和KUB检查诊断为输尿管下段结石。男性2例,女性2例;年龄38～56岁;左侧3例,右侧1例;对侧肾脏重度积水致无功能肾脏1例,对侧肾切除致孤立肾3例;临床表现均为不同程度的患侧腰腹部疼痛和少尿或无尿;无尿或少尿时间约6～11h,平均约9h。术前口服坦索罗辛0.4mg,局麻下急诊经尿道输尿管镜取石或钬激光碎石,并留置双J管。结果手术时间10～25min,平均16.7min;术后1h内均恢复排尿;术后1d检查肾功能1例正常,3例1周内恢复;住院时间4～8d,平均6.5d;拔除双J管前复查KUB均未发现输尿管内结石残留。结论局麻下急诊经尿道输尿管镜碎(取)石术,是治疗孤立肾输尿管下段结石梗阻致无尿或少尿的一种可行的方法,能够迅速处理结石并保护肾功能。

Objective To evaluate the safety and effect of the emergency treatment of stone in lower ureter using ureteroscope lithoclasty （stone removed） under local anesthesia. Methoda From February 2007 to November 2009, the stone in lower ureter were diagnosed by color Doppler and KUB in 4 cases （2 males and 2 female）. They were 38 to 56 years old （mean 46）. Three cases was in the left ureteral and 1 in the right. One case was contralateral non-functioning kidney resulted from severe hydronephrosis, 3 cases were solitary kidney resulted from contralateral nephrectomy, The clinical symptoms were lumbodynia and bellyache in different degree and oliguria or anuria. The lasting time of oliguria or anuria was about 6-11 hours （mean time 9）. Ureteroscope lithoclasty combinating holmium laser （stone removed） under non-drugged state was practised in emergency after taking Tamsulosin （0.4 mg）, and a double J stent was placed in the end. Results The lasting time of the operation was about 10 to 25 minutes （mean 16.7）. The urination was recovered 1 hour after operation and gross hematuria disappeared within 2 days in all the patients. The renal function was normal in 1 case 1 day after operation, and recovered in 3 cases within I weeks. The duration of stay was from 4 to 8 days （mean 6.5）. Remained ureteral stone was not found by color Doppler before removing the double J stent. Concluaions The urgent ureteroscope lithoclasty （stone removed） under local anesthesia can cure stone and conserve renal function in time, and is a safe and effective method in treating the oliguria or anuria resulted by obstruction of stone in inferior segment of the ureter in solitary kidney patients.