经皮肾镜一期治疗继发性上尿路狭窄合并肾结石

One-stage Percutaneous Nephroscopy for Secondary Upper Urinary Stricture Combined with Renal Calculi

目的：探讨经皮肾镜一期治疗继发性上尿路狭窄合并肾结石的可行性与临床疗效。方法回顾分析我院2006年7月～2013年7月97例继发性上尿路狭窄合并肾结石的临床资料。建立F24标准经皮肾镜操作通道，超声联合气压弹道将结石击碎并吸出体外，应用自制电钩或钬激光直视下将狭窄段切开。放置F5双J管2枚内引流。结果93例一期手术成功，手术时间30～180 min，平均75 min。1例因输尿管管腔完全闭塞，改开放手术；2例穿刺出脓性尿液，肾镜下碎石取石后，放置肾造瘘，二期内切开术；1例碎石时间较长，改二期内切开术。93例一期手术成功者术后随访3个月～3年，平均12个月。治愈84例，有效6例，无效3例。结论经皮肾镜一期治疗继发性上尿路狭窄合并肾结石，临床效果较好，手术创伤较小，术后恢复好、快，安全，具有可重复性的优点。

Objective To investigate the feasibility and the efficacy of one-stage percutaneous nephroscopy in the treatment of secondary upper urinary stricture combined with renal calculi. Methods A retrospective analysis was carried out on clinical data of 97 patients with secondary upper urinary stricture complicated with renal calculi from July 2006 to July 2013. Percutaneous nephroscopy was performed through the F24 standard approach.The renal stones were broken and sucked out by the combination of pneumatic and ultrasonic measures.The ureterostenosis segment was opened by using endoscopic incision with monopolar or holmium laser.Two F5 D-J stent were placed after the operation. Results The operation was successfully accomplished in one session in 93 patients.The operation time ranged from 30 to 180 min, with a mean of 75 min.Conversion to open surgery was required in 1 patient because of complete ureteral occlusion.Two patients with renal stones were accompanied with pyonephrosis, and after a renal cannula was indwelled after stone breaking, a second endoscopic operation was performed.One patient experienced a long operation time, and then cured by a secondary endoscopic surgery.Postoperative follow-up for 3 months to 3 years （ mean, 12 months） in the 93 cases of one-stage percutaneous nephroscopy showed 84 cases of cure, 6 cases of effective outcomes, and 3 cases of ineffective results. Conclusion Percutaneous nephroscopy in one session for the treatment of secondary upper urinary stricture combined with renal calculi is effective, minimally invasive, safe, and repeatable.