经皮肾镜联合输尿管镜治疗双J管长期滞留并发结石

Percutaneous nephrolithotomy combined with ureteroscopy in the treatment of calculi caused by longterm retention of double J tube

目的:探讨经皮肾镜联合输尿管镜治疗长期留置双J管所致结石的临床疗效。方法:2010年7月至2020年5月我院收治双J管两端及体部结石患者7例,6例于截石位先行经尿道输尿管镜碎石,清除膀胱内、输尿管壁间段及下段管壁的结石,1例Bricker术后患者采用软性膀胱镜清除输出道内管壁的结石。改变患者体位为俯卧位,X线或超声引导下建立经皮肾镜手术通道,充分清除结石后,顺行取出导管。结果:7例患者中,2例重度肾积水的患者术前行肾穿刺造瘘,5例一期完成治疗,顺利完整取出导管,无严重并发症发生,随访3~12个月,输尿管无狭窄发生。结论:经皮肾镜联合输尿管镜处理长期留管所致的严重双J管结石,是一种安全、有效的手术方法,可完全清除结石,安全取出导管,降低术后输尿管狭窄的发生率。

Objective To investigate the clinical effect of percutaneous nephrolithotomy(PCNL)combined with ureteroscopy in the treatment of calculi caused by long-term indwelling double J tubes.MethodsFrom July 2010 to May 2020,seven patients in our hospital with double J tube stones at both ends and body part were admitted.Six patients were treated with tranurethral ureteroscopic lithotripsy at lithotomy position to clear the stones in the innerbladder,the intersegment and thelower segment ofthe ureteral wal.One patient underwent soff cystoscopy to remove the stones in the inner wall of the output canal.The patient was changed to the prone position,and the percutaneous nephrolithotomy channel was established under the guidance of X-ray or ultrasound.After the calculi were sufficiently removed,the catheter was removed anterograde.ResultsThere were7 patients,2 patients with severe hydronephrosis received renal puncture and nephrostomy preoperatively,and 5 patients completed treatment in the frst stage.All seven patients completed the treatment,and completely without serious complications.During 3-12 months of follow-up,no ureteral stenosis occurred.ConclusionPercutaneous nephrolithotomy combined with ureteroscopy is a safe and effective surgical method for treating severe double J tubular calculi caused by long-term catheter retention,which can completely remove the calculi,safely remove the catheter,and reduce the incidence of postoperative ureteral stricture.