复杂上尿路结石手术中纤维胆道镜的应用

Management of upper urfnary tract calcuti with ureterolithotomy and choledochotiberscopy

目的探讨纤维胆道镜在复杂上尿路结石手术中的应用价值。方法将纤维胆道镜应用于输尿管多发结石、输尿管结石并肾结石以及输尿管结石移位的手术中取出结石。结果 21例中19例纤维胆道镜取石成功(其中1例有2个米粒大结石残留于肾盏内,出院后2周内排出),2例失败后改行传统手术。结论纤维胆道镜应用于复杂上尿路结石手术中治疗效果较好、损伤小、是一种安全有效的方法。值的推广应用;对于用纤维胆道镜取石困难、估计损伤较大的病例,采用传统方法延长切口取石为宜。

Objectve To evaluate our experience in ureterolithotomy treating complicated upper urinary tract calculi with cholodo-chofiberacope. Methods Twenty - one patients underwent ureterolithotomy for complicated upper urinary tract calculi (double ureteral calculi, ureteral calculi disolcation, combined ureteral and renal calculi) . The cholechofiberscope, forceps and syringe were applied to remove ureteral and/or renal stones. Results In patients with combined ureteral and renal calculi 13 of 14 (85.7%) were rendered stone free except for 1 patient who had two 3 - mm residual fragments in the kidney. All of the double ureteral calculi (2 cases) and calculi dislocation to proximal meter (4 cases) were successfully removed. 2 cases were treatment failure with cholechofiberscope for one with large kidney stones and forceps were out of touch them and the other with stone dislocation to distal ureter. Conclusions It is a safe and reliable method for the treatment of complicated upper urinary tract calculi with ureterolithotomy and choledochofiberscopy. To those with difficulty to remove stones by choledo-chofiberscope, traditional operation by enlarging incision is an appropriate selection.