经皮肾镜联合输尿管镜应用钬激光治疗输尿管上段大结石

Percutaneous Nephroscope(PCNL) Combined with Pneumatic Ultrasonic Lithotripsy by Ureteroscope(URL) in Treating Big Upper Ureter Stone by Holmium Laser

目的经皮肾镜联合经尿道输尿管镜钬激光术治疗输尿管上段较大结石的方法。方法采用经皮肾镜联合经尿道输尿管镜钬激光碎石术治疗输尿管上段结石20例。应用输尿管镜将输尿管上段结石推到肾盂,并留置输尿管导管,再应用B超引导下肾盂穿刺,扩张建立F20经皮肾通道,采用钬激光碎石,并主动吸出结石。结果前诊断20例均为一侧输尿管上段结石,平均长短1.86cm。16例Ⅰ期手术取尽结石术,3例Ⅰ期手术后行ESWL排尽结石,1例术中转开放手术。碎石清石时间45～92min,平均63min。肾造瘘术后7～12d拔出肾造瘘管,4周拔出双J管。全组病人术中及术后为发现严重感染及大量失血等严重并发症。结论经皮肾镜联合输尿管镜应用钬激光可以作为治疗输尿管上段大结石的首选方案。

Objective To evaluate the methods and effects of percutaneous nephroscope（PCNL） combined with pneumatic ultrasonic lithotripsy by ureteroscope（URL） in treating big upper ureter stone by Holmium laser.Methods 20 cases of big upper ureter stone were treated by PCNL and URL by holmium laser.Ureterscopy was used to push upper ureteral calculi to the pelvis where ureteral catheter was kept.Percutaneous working channel F20 for nephroscopy was established through renal pelvis puncture under B ultrasound guidance.Ureteral calculi was crushed by holmium laser,and the urinary tract calculi was tried for fragmenting and sucking out by using nephroscope F20.Results Preoperative diagnosis of 20 cases were one side of the upper ureteral calculi,average length of which was 1.86 cm.16 cases were sucked out on stage I;3 cases were exhausted by ESWL after stage I operation;one case was turned to open operation.The time used for the treatment of upper ureteral calculi was 45~ 92 min.,and the average time was 63 min.The renal cannula was extracted after 7~12 days,and the double J cannula was extracted after 4 weeks.All patients in surgery and after surgery found no serious complications of severe infection and massive blood loss.Conclusions The method of percutaneous nephroscope（PCNL） combined with pneumatic ultrasonic lithotripsy by ureteroscope（URL） in treating big upper ureter stone by Holmium laser can be used as preferred solution.