上尿路结石的治疗方法比较(附3218例报告)

A comparative sutdy of various means for the treatment of upper urinary tract calculi (report of 3218 cases )

目的 探讨上尿路结石的治疗方法。 方法 对 32 18例上尿路结石患者的临床分类和治疗方法作回顾性分析。本组单纯性肾结石 136 5例 ,复杂性肾结石 6 5 1例。输尿管结石横径 <0 .8cm ,首次肾绞痛发作时间在 1周以内 ,估计结石在输尿管内停留时间 <4周 ,IVU示造影剂可通过结石者 (Ⅰ组 ) 5 5 8例 ;结石横径 >1.0cm ,估计结石停留时间 >4周 ,IVU示有不同程度肾积水者 (Ⅱ组 )4 5 2例 ;结石横径 >1.0cm ,估计结石停留时间超过 6个月 ,有严重肾积水或结石呈锯齿状、结石下方有息肉或输尿管扭曲成角者 (Ⅲ组 ) 192例。 结果 本组手术取石 116 4例 ;ESWL治疗 192 3例 ;输尿管镜直视下碎石 131例。复杂性肾结石手术残余结石 5 7例 (8.8% ) ,行肾切除 12例 (1.8% )。ESWL组 3个月内排石率 81.6 % ,转手术率 18.4 %。输尿管镜下气压弹道碎石效果不佳改行手术取石 8例(6 .1% )。 结论 ESWL、输尿管镜直视下碎石、术中应用气压弹道式碎石或两种以上方法联合应用治疗上尿路结石可减轻患者痛苦或降低手术难度。开放性手术放置内引流可减少术后并发症。ESWL治疗应积极处理石街、控制感染和最大限度减轻医源性肾功能损害。输尿管镜直视下碎石需熟练的内腔镜操作技术。

Objective To study and evaluate various therapeutic means for upper urinary tract calculi. Methods 3 218 cases of upper urinary tract calculi were reviewed.1 365 were pure kidney stones,651 complicated kidney stones,558 group Ⅰ ureteral stones,452 group Ⅱ ureteral stones and 192 group Ⅲ ureteral stones. Results ESWL (extracoporeal shock wave lithotripsy) has been the treatment of choice for pure kidney stones and for groupⅠ ureteral stones.Open surgery has been the best for complicated kidney stones and group Ⅱ,Ⅲ ureteral stones.1 164 patients underwent lithotomy and 1 923 ESWL.131 cases of group Ⅱ ureteral stones in the middle or lower segment of ureter were treated by ureteroscopic lithotripsy.Of the complicated kidney stones,residual stones were observed in 57 (8.8%).1.8%( n =12) of such cases underwent nephrectomy.The complete stone elimination rate in 3 months after ESWL was 81.6% whereas open operation was needed in 18.4%.Ure teroscopic lithotripsy yielded the poorest outcome,nephrectomy being undertaken afterwards in 0.8% and lithotomy in 6.1%. Conclusions ESWL,ureteroscopic lithotripsy,ballast lithotripsy or the combined use of 2 methods makes the surgical management of upper urinary tract calculi easier with less suffering to the patients.The use of double internal stent could reduce the surgical complications.Stone street after ESWL should be well taken care of and inflammation should be well controlled.Skilled technique is needed for ureteroscopic lithotripsy.