双侧全程尿路结石的处理(附3例报告)

The therapy of bilateral total urinary tracts calculi:report of 3 patients

目的:探讨双侧全程尿路结石的微创治疗方法。方法:回顾性报告3例因双J管留置时间过长或下尿路梗阻继发双侧全程尿路结石患者的微创分期治疗过程,并复习有关文献予以讨论。结果:3例患者均为膀胱、双侧输尿管及双侧肾结石患者,入院后先行ESWL,然后再行手术治疗。一期利用输尿管镜碎石取石(uret-erorenoscope lithotripsy,URL)处理膀胱及双侧输尿管结石,二期采用经皮肾镜碎石取石(percutaneous nephro-lithotomy,PCNL)将双侧肾及双侧输尿管上端结石清理干净,并将滞留的双J管顺利拔除。术后复查结石基本清理干净,肾功能好转,患者症状均消失。结论:输尿管镜碎石取石术处理膀胱及输尿管中下段结石,结合二期经皮肾镜碎石取石术处理肾及输尿管上段结石,是治疗双侧全程尿路结石的理想选择,值得推广。

Objective：To investigate the minimally invasive strategy for treating the bilateral total urinary tracts calculi. Methods：We reported the minimally invasive treatment strategy in 3 cases of bilateral total urinary tracts calculi,secondary to the long term indwelling double J stent or lower urinary obstruction. And then we review the previous reports. Results： All of the three cases have calculus in bladder, bilateral ulreter and kidney, extracorporeal shock-wave lithotripsy（ESWL） was administrated first, and then was the operation. At one stage, ureteroscopic lithotripsy（URL） was performed in all 3 cases in order to remove the bladder and bilateral ureter stones. Then all patients were undergone percutaneous nephrolithotomy（PCNL） procedures to deal with the bilateral kidney and upper ureter stones at the second stage. The indewelling double J stents were taken out at the same time. The related symptoms in all cases disappeared after the operation. Re-examnation shows that the stones was almost cleaned up and the renal function was recovered. Conclusions： Ureteroscopic lithotripsy for bladder and ureters, incorporate with percutaneous nephrolithotomy dealing with kidney and upper ureteral stones,is the ideal choose for bilateral total urinary treat calculi.