mPCNL治疗盂管结石合并重度脊柱侧弯二例

Effect of minimally invasive percutaneous nephrolithotomy in the treatment of ureteropelvic junction obstruction complicated with severe scoliosis:a report of 2 cases

目的探讨微创经皮肾镜碎石取石术(mPCNL)治疗盂管结石合并重度脊柱侧弯的可行性、安全性及疗效。方法遵义医科大学附属医院泌尿外科分别于2018年4月9日与2018年8月30日收治2例盂管交界结石合并重度脊柱侧弯畸形患者,术前已行尿路CT成像(CTU)、逆行肾盂造影(RP)检查,盂管结石诊断明确。手术体位均选择截石斜卧位,B超引导下微通道经皮肾穿刺术,术中采用钬激光碎石术。结果病例一术后第5天复查腹部平片(KUB),双J管位置良好,未见结石残留;病例二术后第6天复查KUB,双J管位置良好,未见结石残留;2例患者术中、术后均未出现大出血、胸膜损伤、肠道损伤、肝脾损伤、输尿管穿孔、尿瘘、尿源性脓毒血症等并发症,术后随访恢复好。结论盂管结石并重度脊柱畸形患者行mPCNL是一种最低限度损伤的手术方式,并可获得满意的结石清除率。B超引导安全有效,可减少周围脏器的损伤。

Objective To investigate the feasibility, safety and efficacy of minimally invasive percutaneous nephrolithotomy (mPCNL) in the treatment of ureteropelvic junction obstruction with severe scoliosis. Methods Two patients with ureteropelvic junction obstruction complicated with severe scoliosis were admitted to the Department of Urology at the Affiliated Hospital of Zunyi Medical University on April 9, 2018 and August 30, 2018, respectively. CT urography (CTU) and retrograde pyelography (RP) were performed before operation, and the result was clearly diagnosed as a ureteropelvic junction obstruction. The lithotomy reclining position was used for all operation. A microchannel percutaneous nephrolithotomy was performed under the guidance of B-ultrasound, and holmium laser lithotripsy was used to remove stones. Results Case 1: The kidney-ureter-bladder (KUB) abdominal radiography was re-examined on the fifth day after operation. The results showed that the double J tube was in good position and no stone residue remained. Case 2: The KUB abdominal radiography was re-examined on the sixth day after operation, and the double J tube was in good position and no stone remained. In the two patients, there were no complications such as massive hemorrhage, pleural injury, intestinal injury, liver and spleen injury, ureteral perforation, urinary fistula and urinary sepsis during and after operation. Postoperative follow-up showed good recovery. Conclusion mPCNL is a minimally invasive surgical procedure for patients with ureteropelvic junction obstruction and severe scoliosis, and satisfactory stone clearance can be achieved. B-ultrasound guidance is safe and effective, reducing damage to surrounding organs.