经皮肾镜碎石联合顺行性球囊扩张治疗复发性肾结石合并输尿管上段狭窄20例分析

Percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi

目的探讨经皮肾镜碎石联合顺行性球囊扩张治疗复发性肾结石合并输尿管上段狭窄的方法与疗效。方法回顾性分析20例有肾及输尿管上段开放性手术史、术后复发肾结石合并输尿管上段狭窄患者的临床资料，应用经皮肾镜超声气压弹道碎石取石，联合使用球囊扩张治疗。观察术后结石清除率、肾积水变化情况及并发症，对比手术前后静脉尿路造影（IVU）及CT尿路成像（CTU）检查情况。结果20例均成功建立通道，无中转开放手术病例。术后第3天肾出血1例，予超选择性肾动脉栓塞止血成功；双J管位置不佳1例，予输尿管镜下调整。结石完全清除17例，2例肾下盏残留结石〈5mm未予处理，1例残留肾结石合并感染，反复治疗无效行脓肾切除术。术后随访6—39（12．5±1．9）个月，肾积水由术前的2．5～7．5（3．9±1．2）cm降为术后的2．1—4．0（2．2±0．9）em，差异有统计学意义（P〈0．05），术后患者IVU或CTU检查肾显影改善。结论经皮肾镜超声气压弹道联合顺行性球囊扩张是治疗复发性肾结石合并输尿管上段狭窄安全有效的方法。

Objective To analyze the technique and clinical effect of percutaneous nephrolithotomy combined with endoscopic balloon dilation in the treatment of upper ureterostenosis with recurrent renal calculi. Methods From February 2009 to May 2012,20 ureteral stenosis patients with the history of ureteral open surgery,postoperative residual or recurrent kidney renal calculi were treated. Fifteen cases were with hydronephrosis of 2-4 cm,4 cases were with hydronephrosis of 5-6 cm and 1 case was with hydronephrosis 〉 6 cm. Subsequent calculi size 〈 1 cm was found in 16 cases, 1 - 3 cm in 3 cases, 〉 3 cm in 1 case. All patients were treated with percutaneous nephrolithotomy ultrasonic lithotripsy combined with balloon dilatation. The calculi clearance rate, hydronephrosis changes,complications,intraverous urography （IVP） and CT urography （CTU） situation before and after surgery were analyzed. Results All the 20 cases were completed surgery successfully. There was 1 case with renal hemorrhage 3 d after surgery and controlled with DSA hemostasis. There was 1 case accepted adjusting double-J tube by ureteroscopy. Seventeen patients＇ calculi were completed removed. Two cases with residual calyceal calculi size 〈 5 mm was not further treated. There was 1 case treated with nephrectomy because of renal calculi with infection. The patients were followed up for 6 - 39 （ 12.5 ±1.9） months. Hydronephrosis improved significant changes [ 2.1 - 4.0 （2.2 ± 0.9） cm vs. 2.5-7.5 （3.9 ± 1.2） cm, P〈0.05]. All patients achieved significant improvement in IVP and CTU comparing of preoperative and postoperative data. Conclusion The use of percutaneous nephrolithotomy combined with endoscopic balloon dilation is a safe and effective treatment option in the treatment of kidney calculi with ureteral stenosis.