多镜联合治疗复杂性上尿路结石

Multi endoscope in treatment of complex upper urinary tract calculi

目的探讨多镜联合治疗复杂性上尿路结石的方法及疗效。方法该研究采用输尿管镜、肾镜联合输尿管软镜治疗复杂性肾和输尿管上段结石435例,其中单纯输尿管上段结石185例（结石直径0.8~1.5 cm）,合并肾盂肾盏多发结石112例（结石直径0.6~1.2 cm）,对单纯肾脏多发结石96例（结石直径0.6~2.2 cm）,鹿角状结石42例（结石直径为2.0~4.1 cm）采用一期行经皮肾镜取石术治疗,术毕常规留置F18硅胶肾造瘘管及输尿管内双J管,术后常规抗感染治疗5~7 d;根据术后复查腹部平片情况,7~10 d后拔除肾造瘘管或对残留结石二期用输尿管软镜激光碎石取石术,常规术后2周左右拔除输尿管内双J管。结果输尿管镜一次进镜成功率96.0%,单次碎石成功率74.0%（137/185）。联合输尿管软镜或肾镜治疗后,总结石排净率为100.0%（185/185）,手术时间30~160 min,术后平均住院7 d,其中4例出现寒颤、高热,对于经皮肾镜联合输尿管软镜的患者,穿刺成功率100.0%,单次碎石成功率100.0%（298/298）,总结石排净率79.9%（238/298）,36例出现高热、寒颤,26例穿刺道出血。结论多镜联合是治疗复杂性上尿路结石的有效方法,它具有清石率高、安全、微创和并发症少等优点,临床值得推广。

Objective To investigate multiple endoscopies combination therapy methods and curative effect of complicated upper urinary tract calculi. Methods 435 cases of complex renal and upper ureteral calculi, including186 cases of ureteral calculi（Stone diameter 0.8 ~1.5 cm）, 112 cases complicated with renal multiple renal calculi（Stone diameter of 0.6~1.2 cm）, 96 cases（Stone diameter 0.6~2.2 cm） of simple kidney stones. 42 cases of staghorn stones（Stone diameter 2.0~4.1 cm）, we use a period for percutaneous nephrolithotomy treatment, postoperative routine F18 indwelling silicone renal fistula and ureter within double J tube, postoperative routine anti infection treatment of 5~7 d; according to the KUB after operation, 7~10 d after removal of residual stones or renal fistula two period with flexible ureteroscope laser lithotripsy, routine postoperative 2 weeks pulling out ureter within double J tube.Results Ureteroscope into the mirror a success rate of 96.0%, the success of a single stone rate was 74.0%（137/185）. The net rate of total row of stones was 100.0%（185/185）, operation time of 30~160 min, the average postoperative hospitalization was 7 d, including 4 cases of chills and fever, for percutaneous nephrolithotomy combined with flexible ureteroscope group, the successful rate of puncture was 100.0%, the success of a single stone rate was100.0%（298/298）, the total stone free rate 79.9%（238/298）, 36 cases of high fever, chills, 26 cases of delayed hemorrhage. Conclusion A variety of combined endoscope is an effective method for treatment of complex upper urinary tract calculi, it has the advantages of high stone clearance rate, safe, minimally invasive, less complications, is worthy of promoting in clinical practice.