双侧输尿管中上段结石梗阻的同期处理

Simultaneous treatment for bilateral upper urinary tract stone obstruction

目的探讨双侧输尿管中上段结石合理的处理方法。方法 2009年9月—2010年8月收治双侧输尿管中上段结石患者9例。4例存在急性肾衰,血肌酐401～1 552μmo/L。双侧输尿管镜钬激光碎石4例;一侧输尿管镜下钬激光碎石,另一侧输尿管切开取石1例;一侧留置双J管,另一侧输尿管切开取石2例;双侧输尿管切开取石2例。结果所有患者均同期解除梗阻,肾衰患者肾功能恢复良好。除2例单侧留置双J管,结石进入肾盂,术后结合ESWL排出结石外,余未见残余结石。结论双侧输尿管中上段结石致上尿路梗阻,应及时解除梗阻。输尿管镜创伤小,多可同期解除双侧梗阻,可作首选。患者身体条件许可时,开放性手术也能同期解除双侧梗阻。

Objective To evaluate the reasonable treatment methods of bilateral upper urinary tract stone.Methods 9 cases of bilateral upper urinary tract stone were treated from September 2009 to August 2010.Among the 9 cases,4 cases had acute renal failure,serum creatinine 401~1552umol/L.4 cases treated via bilateral ureteroscopy with Hol：YAG laser lithotripsy.1 case had via ureteroscopy with Hol：YAG laser lithotripsy on one side and underwent ureterolithotomy on the other side.2 cases treated with drainage of indwelling double J tube on one side and underwent ureterolithotomy on the other side.2 cases underwent bilateral ureterolithotomy.Results All patients had relieved the obstruction at the same period,patients with acute renal failure had a good recovery,No residual stones in all cases,except 2 patients with unilateral indwelling double-J tube,stone into the renal pelvis,after combining ESWL,stones successfully discharged outside.Conclusion Bilateral ureteral stones in upper urinary tract leading to the obstruction,we should promptly relieve the obstruction.Ureteroscopy can be used as a priority because of its less invasive;more can be lifted bilateral obstruction at the same period.If the patient＇s physical conditions permit,open surgery will also achieve the same effect to lift bilateral obstruction.