一期肾造瘘二期输尿管镜碎石术治疗输尿管上段结石

Primary nephrostomy and secondary ureteroscopic lithotripsy for upper ureteral calculi

目的 探讨输尿管上段结石致重度肾积水患者行一期肾造瘘二期造瘘管(由肾脏远端至近端)冲水输尿管镜碎石术治疗的临床效果。方法 选择2021年2月至12月由于输尿管上段结石嵌顿过久所致的重度肾脏积水患者30例,根据患者住院诊治期间采用的不同手术治疗方式分为对照组和观察组,每组各15人。对照组采用传统输尿管镜碎石术治疗,观察组采用一期肾造瘘二期造瘘管(由肾脏远端至近端)逆行冲水输尿管镜碎石术治疗。比较两组治疗效果及愈后情况。结果 结石清除率观察组患者为93.33%,对照组患者为73.33%;术后发热或炎性反应发生率观察组患者为6.66%,对照组患者为26.66%。两组差异具有统计学意义(P<0.05)。结论 采用一期肾造瘘二期造瘘管(由肾脏远端至近端)冲水进行输尿管镜碎石术治疗输尿管上段结石嵌顿过久所导致的重度肾脏积水,结石清除率明显上升,能够有效避免术后发热或炎性反应的发生。

Objective To investigate the clinical effect of primary nephrostomy and secondary nephrostomy(from distal to proximal kidney)in the treatment of severe hydronephrosis caused by upper ureteral calculi.Methods From February to December 2021,30 patients with severe hydronephrosis caused by stone incarceration in the upper ureter for too long were selected,and were divided into control group and observation group according to different surgical treatment methods adopted during hospitalization,with 15 patients in each group.The control group was treated with traditional ureteroscopic lithotripsy,while the observation group was treated with one-stage nephrostomy and two-stage fistulation(from the distal to the proximal end of the kidney)with retrograde flushing ureteroscopic lithotripsy.Compare the treatment effect and recovery of the two groups.Results The stone clearance rate was 93.33%in the observation group and 73.33%in the control group;The incidence of postoperative fever or inflammatory reaction was 6.66%in the observation group and 26.66%in the control group.The difference between the two groups was statistically significant(P<0.05).Conclusion The primary nephrostomy and secondary nephrostomy(from the distal end of the kidney to the proximal end)were used to flush water for ureteroscopic lithotripsy in the treatment of severe hydronephrosis caused by too long incarceration of upper ureteral calculi.The stone removal rate increased significantly,which can effectively avoid postoperative fever or inflammatory reaction.