上尿路结石手术治疗方法的探讨(附3620例报告)

Investigation of operative method for upper urinary tract calculi(report of 3 620 cases)

目的：探讨上尿路结石的手术治疗方法。方法：回顾性分析2008年1月～2013年3月收治的3620例上尿路结石患者的临床资料：采用输尿管硬镜取石术（URL）1498例，输尿管软镜取石术58例，微创经皮肾镜取石术（mini—PCNL）1529例，标准通道经皮肾镜取石术（标准通道PCNL）445例，腹腔镜输尿管切开取石术56例，开放手术34例。结果：3620例中，URL对输尿管中、下段结石取净率为98．8％（1480／1498），上段为87．6%，术中无输尿管穿孔和撕脱并发症发生，术后脓毒血症1例（0．07％）。输尿管软镜结石寻及率为96．6％（56／58），一次手术碎石成功率为93．1％，术中无输尿管、肾盂穿孔和大出血并发症发生。PCNL对肾盂和输尿管上段结石取净率为99．5％（1964／1974），鹿角形结石为89．2％。术后输血49例（1．4％），因大出血需行肾动脉超选择性栓塞10例（0．3％），肾切除1例，脓毒血症8例（0．2％）。腹腔镜治疗56例均获得成功，其中1例结石上行至肾脏，余无并发症发生。开放手术34例全部成功，无并发症发生。结论：腔内技术可用于治疗各种类型的上尿路结石患者，同时具有创伤少、结石清除率高、严重并发症低等优点。

Objective： To investigate the operation of treating upper urinary tract calculi. Method： The study was taken from January 2008 to March 2013 in 3 620 patients with upper urinary tract calculi. Ureteroscopic litho- tripsies （URL） were taken in 1 498 cases. Fifty-eight patients were treated with Ho：YAG laser with flexible uret- eroscope. Mini-percutaneous nephrolithotomies （mini-PCNLs） were done in 1 529 cases. Four hundred and forty- five patients underwent standard-tract percutaneous nephrolithotomy. Fifty-six cases were performed laparoscopic ureterolithotomy. Thirty-four cases received open surgery. Result：The stone-free rate of URL was 98.8% （1 480/ 1 498） for middle and lower ureteral stone, and 87.6% for upper ureteral stone. There was one patient with urine sepsis after operation. No ureter perforation and avulsion appeared. The detection rate and one-session success rate were 96.6% （56/58） and 93. 1% respectively. There was no ureter or renal pelvic perforation and massive hemorrhage happened. The stone-free rate of PCNL was 99. 5% （1 964/1 974） for pelvic and upper uretera[ stone, 89.2% for stag-horn stone respectively. There were 49 cases （1.4%） required blood transfusion. Ten ca- ses （0.3%//00） needed selective renal arterial embolization. Nephreetomy was taken in one patient. Eight patients suffered from sepsis after operation. Fifty-six patients treated with retroperitoneal laparoscopic ureterolithotomy recovered well although one of them was observed dislocation of the stone to kidney. No other complications oc- curred during retroperitoneal laparoscopic procedure. All open surgeries were successful without any complica- tions. Conclusion：Upper urinary tract calculi can be managed by endourologic technique for its high stone-free rate and low complication rate.