双镜联合同期处理肾盂输尿管连接部梗阻合并肾盏结石14例报告

Report of laparoscopic pyeloplasty combined with flexible ureteroscopic surgery for 14 cases of UPJO with secondary calyceal calculi

目的总结我院泌尿外科应用腹腔镜联合输尿管软镜技术同期治疗肾盂输尿管连接部梗阻(UPJO)合并继发肾盏结石的临床经验。方法回顾性收集2019年1月至2020年3月实施经腹腔途径腹腔镜肾盂成形术同期行输尿管软镜碎石取石术的14例患者的临床资料,分析结石大小、数目、手术时间、手术并发症及结石成分等指标。结果左侧病例9例,右侧5例,术前通过磁共振尿路成像(MRU)、逆行肾盂造影及CT检查明确为UPJO合并继发肾盏结石,积水为中度到重度。所有手术均同期完成,其中2例有残余结石。所有病例均无副损伤及中转开放;术中发现结石为1~15块,直径2~25 mm;手术时间130~270 min,平均(180±36)min;术中出血量20~100 mL,围手术期均未输血。术后均无漏尿发生,所有患者均顺利恢复,术后3~5 d拔除引流管,术后住院3~6 d(平均4 d),术后6~8周行膀胱镜拔除双J管,复查肾积水均明显缓解。病例随访6~21个月,随访期内肾积水无加重。结论经腹腹腔镜联合输尿管软镜技术治疗UPJO合并继发肾盏结石安全有效,且创伤小、出血少、清石率高,是UPJO合并继发结石患者的较好选择,值得临床推广应用。

Objective To summarize our experience in the treatment of ureteropelvic junction obstruction(UPJO)with secondary calyceal calculi using laparoscopic pyeloplasty combined with flexible ureteroscopic surgery.Methods The clinical data of 14 patients suffering UPJO with secondary calyceal calculi treated with transperitoneal laparoscopic pyeloplasty and flexible ureteroscopic lithotripsy simultaneously during Jan.2019 and Mar.2020 were reviewed.The numbers and sizes of calculi,operation time,complications and stone components were analyzed.Results The lesions were in the left side in 9 cases and in the right side in 5 cases.All diagnoses were confirmed with preoperative magnetic resonance urography(MRU),retrograde pyelography and CT.All cases had moderate to severe hydronephrosis.All operations were completed without subsidiary injury or conversion to open operation,including 2 cases with residual calculi.The numbers of calculi were 1-15 and the diameters of them were 2-25 mm.The average operation time was(180±36)min(range 130-270 min),and mean estimated blood loss was 20-100 mL,without blood transfusion.No urine leakage occurred after operation.The drainage tubes were removed 3-5 days after operation,and postoperative hospital stay was 3-6 days(average 4 days).The double-J stents were removed 6-8 weeks after surgery.During the follow-up of 6-21 months,hydronephrosis was significantly relieved without aggravation in all cases.Conclusion Laparoscopic pyeloplasty combined with flexible ureteroscopic surgery is safe,minimal invasive and effective in the treatment of UPJO with secondary calices calculi,with little bleeding and high stone-clearance rate.It is a good alternative therapy for UPJO with secondary calculi and worthy of clinical promotion.