ESWL与腔内技术联合处理复杂性上尿路结石

Combination of ESWL and endoscopic manipulation in the treatment of complex upper urinary tract calculi

目的 探讨复杂性上尿路结石的治疗方法。 方法 对近期 138例复杂性上尿路结石患者 ,采用体外冲击波碎石 (ESWL)与输尿管镜下气压弹道碎石 ,经皮肾微穿刺造瘘碎石、取石等腔内技术联合治疗。其中复杂性输尿管结石 110例 ,复杂性肾结石 2 8例 ,均有不同程度肾积水。对输尿管结石先行ESWL ,2 4h内再行输尿管镜下气压弹道碎石 ;对肾结石及输尿管镜碎石困难的输尿管上段结石 ,先一期行经皮肾微穿刺造瘘术 ,5～ 7d后行ESWL ,2 4h内再经肾造瘘通道行输尿管镜下气压弹道碎石、取石。 结果 结石总排净率为 97.1% (134/138) ,其中输尿管结石排净率为10 0 .0 % (110 /110 ) ,肾结石排净率为 85 .7% (2 4 /2 8)。无治疗失败病例。 结论 ESWL与腔内技术联合处理复杂性上尿路结石 ,降低了腔内手术难度 ,缩短了腔内操作时间 ,提高了结石排净率 ,患者创伤小 ,恢复快 ,并发症少 ,是治疗复杂性上尿路结石较理想的方法。

Objective To investigate the treatment of complicated upper urinary tract calculi. Methods 138 cases of upper urinary tract calculi were treated by the combination of extracorporeal shork wave lithotripsy (ESWL),ureteroscopic lithotripsy and minimally invasive percutaneous nephrolithotomy were reviewed.There were 110 cases of complex ureteral stone and 28 cases of complex kidney stone among the group.All cases had variable degree of hydronephrosis.The treatment program for complex upper urinary tract calculi was initially,ESWL and followed by ureteroscopy and pneumatic lithotripsy in 24 hours.For the complex kidney stone and upper ureteral stone,which was difficult for ureteroscopy lithotripsy.The program was firstly percutuneous minimal pyelostomy,ESWL after 5～7 days,then urteroscopy lithotripsy and lithotomy through the fistula in 24 hours. Results Total stone-free rate was 97.1%(134/138),in ureteral stone group was 100%(110/110),in kidney stone group 85.7%(24/28).Satisfactory result has been observed in all cases. Conclusions The endoscopic manipulation become easy and fast by means of endoscopic manipulation in the treatment of complex upper urinary tract calculi.This technique is minimally invasive and has less complications,it increases the stone-free rate.