硬性输尿管镜鞘配合输尿管镜技术治疗嵌顿性肾盂输尿管移行处结石

Management of incarcerated ureteropelvic junction calculi using ureteroscope via rigid ureteral access sheath

目的探讨硬性输尿管镜鞘配合输尿管镜技术治疗嵌顿性肾盂输尿管移行处结石的有效性及安全性。方法回顾2009年10月至2012年1月我院采用硬性输尿管镜鞘配合输尿管硬镜技术治疗的31例嵌顿性肾盂输尿管移行处结石患者临床资料,分析其手术时间、住院时间、手术效果及并发症情况。结果 23例一期手术取石成功,其中5例需要同时应用软性输尿管肾镜;8例一期手术中未能置入硬性输尿管镜鞘,其中4例一期手术中中转经皮肾镜取石术,另外4例术中留置双J管,两周后再次手术。两周后再次手术的4例中,3例二期手术取石成功,另外1例因仍未能置入硬性输尿管镜鞘而中转经皮肾镜取石术治疗。手术总成功率83.9%(26/31),手术时间23～47min,平均29±11min,术后住院1～5d,平均2.6±1.7d。术后复查KUB或超声,残石直径均<3mm。1例术后发热,无输尿管离断、撕脱、肾盂撕裂等严重术中并发症。术后3个月随访未发现输尿管返流。结论硬性输尿管镜鞘配合输尿管镜技术治疗嵌顿性肾盂输尿管移行处结石疗效确定、安全性好、并发症少。

Objective To assess the efficacy and safety of ureteroscope via rigid ureteral access sheath for incarcerated ureteropelvic junction calculi. Methods Between October 2009 and January 2012, a total of 31 patients underwent technique of ureteroscope via rigid ureteral access sheath for incarcerated ureteropelvic junction calculi. The operating time, hospital stay time, outcome and complications were assessed. Results Twenty-three cases were successfully completed after one session, including 5 cases additionally flexible ureteroscope application. The remaining 8 cases failed to place the rigid ureteral access sheath. In thess 8 cases, 4 cases converted to percutaneous nephrolithotomy, and 4 cases underwent phase - II operation after two weeks dilation with double J stent. Of the 4 cases with double J tube dilation, phase- ]I operations were successfully completed in 3 cases and the other one converted to percutaneous nephrolithotomy for the failure of rigid ureteral access sheath placement. The total success rate was 83.9% （26/31）, and the mean operating time was 29＋11 min （23-47 min）. The patients were discharged from hospital in 1-5 days （mean 2.6＋1.7 days） after operation. All cases had complete calculi clearance with residue calculi smaller than 3 mm under plain radiography of abdomen or B-ultrasonography. One patient suffered from fever after operation. No one suffered from ureteral transaction, avulsion, renal pelvis tearing or other serious complication. Ureteral reflux was not observed after three months follow-up. Conclusions Ureteroscope via rigid ureteral access sheath is a safe and effective option for incarcerated ureteropelvic junction calculi.