经皮肾镜治疗体外震波碎石失败的上尿路结石的临床研究(附视频)

Efficacy of percutaneous nephrolithotomy of upper urinary stones after failed extracorporeal shock-wave lithotripsy treatment

目的探讨经皮肾镜技术应用于体外震波碎石（EswL）治疗失败的上尿路结石的疗效和安全性。方法本组共26例，男19例，女7例，年龄25～67岁，结石直径1～2．5cm，既往均有不同次数ESWL史，行肾镜下超声或气压弹道碎石，对于较低位置输尿管结石者则更换输尿管镜下碎石。结果全部病例均一次性成功建立单通道，通道建立时间6～17min，结石处理时间20～105min，出血量10～30ml。术中发现游离型结石7侧，其余25侧结石周围均有不同程度炎性息肉包裹，结石与周围管壁粘连，6例结石中心有大量基质成分堆积。术后复查清石率75％（24／32），无临床意义残石率25％（8／32）。结论肾镜可有效治疗ESWL治疗失败的上尿路结石。

Objective To investigate the efficacy and safety of percutaneous nephrolithotomy in patients with upper urinary calculi after failed ESWL. Methods A group of 26 cases, 19 males and 7 females, aging from 25 to 67 years with calculi diameter from i cm to 2.5 cm and previous ESWL history underwent percutaneous uhrasounie or pneumatic nephrolithotomy. Ureteroscopic lithotripsy was used for cases with lower ureteral calculi. Results All patients had successfully established single channel in 6 to 17 rain. Calculi dealing time ranged from 20 rain to 105 rain. The blood loss ranged from 10 ml to 30 ml. Isolated calculi were found in 7 sides. In the other 25 sides all calculi were wrapped by varying degrees inflammatory polyps parcel, with some calculi adhering to the ureteral wall. Six cases had accumulation of matrix components in the center of calculi. The stone free rate was 75% （24/32）, while no clinical significance stone residual rate was 25% （8/32）. Conclusion Percutaneous nephrolithotomy was effective for upper urinary stones failed in ESWL.