经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石

Combination therapy of ureteroscopic lithotripsy and percutaneous nephrolithotripsy for complex upper urinary tract calculi

目的探讨经尿道输尿管镜联合经皮肾镜碎石术治疗复杂性上尿路结石的可行性和应用效果。方法 56例均为肾复杂性结石合并同侧输尿管结石肾积水。先取截石位,经尿道置入输尿管镜到达输尿管结石部位,插入钬激光光纤直视下行钬激光碎石术,然后置入F5输尿管导管至肾盂,退出输尿管镜保留输尿管导管,膀胱内置入导尿管。然后取俯卧位,在B超定位下穿刺,根据结石情况行经皮肾镜碎石术,碎石设备为第四代气压弹道超声清石系统。碎石完成后,通过经皮肾镜置入F6双J管,如有结石下移至输尿管或置入双J管不顺利,可再次通过截石位,经尿道置入输尿管镜行钬激光碎石或放置双J管。结果 56例均成功,无中转开放手术,无一例出现输尿管损伤或结肠损伤,所有输尿管结石均一期清除干净,56例有48例肾脏结石清除干净,结石一期清除率为78.6%(44/56),二期结石清除率为80.0%(8/10),结石总清除率为92.8%(52/56)。结论对于复杂性肾结石合并同侧输尿管结石,术前无须行体外冲击波碎石术。采取经尿道输尿管镜联合经皮肾镜碎石治疗,可同时取出输尿管全程和肾内的结石,结石清除率高,是处理复杂性上尿路结石安全、可靠实用的方法。

Objective To investigate the feasibity and effcacy of ureteroscopic lithotripsy combined with percutaneous nephrolithotripsy for complex upper urinary tract calculi.Methods This study included 56 patients with complex renal stones（staghorn or multiple calculi or large stones） and ipsilateral ureteral stones who underwent ureteroscopic lithotripsy combined with percutaneous nephrolithotripsy.All cases were diagnosed by B-mode ultrasound,KUB＋IVU and kidney CT,and all cases were complicated by different degree of hydronephrosis.Firstly,the patients underwent ureteroscopic lithotripsy with holmium laser,then underwent percutaneous nephrolithotripsy with the fourth-generation EMS pneumatic and ultrasound lithotripsy.Results The operations were completed successfully in all the 56 cases and no one turned to open surgery during the lithotripsy.The complete liquidation rate of the stones at stage I treatment was 78.6%,at stage Ⅱ was 80.0%,and the overall rate of stone liquidation was 92.8%.Conclusions The simultaneous treatment of complex renal complex renal stones accompanied by ipsilateral ureter stones becomes reality by ureteroscopic lithotripsy combined with percutaneous nephrolithotripsy,and there was no need for EWSL before opertation.This method has the advantages of safety,high efficacy,convenience and practicality.