Ⅰ期肾穿刺微造瘘Ⅱ期双镜联合治疗复杂性输尿管石街(附27例报告)

Minimally invasive percutaneous nephrostomy in stage Ⅰ and ureteroscopic lithotomy combined with percutaneous nephrolithotomy in stage Ⅱ for the treatment of complicated ureteral calculi steps(Report of 27 cases)

目的:探讨复杂性输尿管石街在临床上有效的微创治疗方法。方法:采用Ⅰ期肾穿刺微造瘘Ⅱ期双镜(输尿管镜碎石+经皮肾镜碎石取石)联合治疗27例复杂性输尿管石街。结果:Ⅰ期B超定位下100%成功完成肾穿刺微造瘘,Ⅱ期双镜联合一次性治疗输尿管石街并肾内结石,清石率92.59%,无术中、术后大出血,无发热及其他重大并发症发生。结论:复杂性输尿管石街发生时多伴有患侧多发性肾结石并明显的肾积水、感染发生和肾功能损害,采用Ⅰ期肾穿刺微造瘘Ⅱ期双镜联合的方式进行治疗术前可有效的判断患肾功能,明显减少术中、术后感染、出血的发生,提高手术安全性和清石率。

Objective：To evaluate the clinical effect of minimally invasive treatment method for the treatment of complicated ureteral calculi steps. Method：Minimally invasive percutaneous nephrostomy in stage Ⅰ and uretero scopic lithotomy combined with pereutaneous nephrolithotomy in stage Ⅱ（URL combined with PCNI. in stage Ⅱ ） were used for the treatment of 27 eases of complicated ureteral calculi steps. Result：Under ultrasonic guidance all minimally invasive percutaneous nephrostomy were successfully established in stage Ⅰ , in stage Ⅱ URL combined with PCNL were used for the treatment of complicated ureteral calculi steps and renal calculi, a 92.59 % stone-free rate was achieved, no serious complications Such as haemorrhage, infection and fever were observed in intraopera- tive and postoperative. Conclusion：Complicated ureteral calculi steps always take place with multiple renal calculi and hydronephrosis, infection and renal damage. Using the way of minimally invasive percutaneous nephrostomy in stage Ⅰ and URL combined with PCNL in stageⅡ for the treatment may judge the renal function in pre-opera- tion, decrease the incidence rate of fever and haemorrhage in intraoperative and postoperative, increase the total calculi clearance rate and improve the success rate of surgery at last.