论文部分内容阅读
目的探讨经皮肾镜下气压弹道碎石联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄的方法与临床疗效。方法回顾性分析2009年8月至2012年8月收治的48例复发性肾结石合并输尿管上段狭窄患者的临床资料。其中男20例,女28例;年龄22~61(35.7±11.8)岁。患者均有肾、肾盂或输尿管上段手术或治疗史,术后结石残留或复发。合并肾积水深度1.0~8.0(2.5±1.1)cm。合并结石直径0.4~3.5(1.2±0.7)cm。输尿管狭窄长度0.3~2.0(0.8±0.4)cm。应用经皮肾镜气压弹道碎石治疗肾结石,联合使用顺行性球囊扩张治疗输尿管上段狭窄。统计结石清除率、肾积水变化及并发症情况,对比手术前后静脉尿路造影(IVU)及CT尿路成像(CTU)检查结果。结果 45例(93.8%)成功建立经皮肾通道,3例中转开放手术。术后并发肾出血4例(8.3%),3例给予超选择肾动脉栓塞止血,1例给予肾切除术;肾周脏器损伤3例(6.2%),保守治疗2例,开放手术处理1例。44例手术成功患者获随访,随访时间6~42(20.3±4.2)个月。随访复查B超及CT示结石清除、肾积水明显减轻或减轻37例,IVU或CTU示输尿管显影通畅无明显狭窄;肾积水无明显变化7例。总有效率84.1%(37/44)。结论经皮肾镜下气压弹道碎石联合球囊扩张治疗复发性肾结石合并输尿管上段狭窄手术效果确切,患者痛苦小、术后恢复快。
Objective To investigate the method and clinical effect of percutaneous nephrolithotomy combined with pneumatic balloon lithotripsy in the treatment of recurrent renal calculi complicated with upper ureteral stenosis. Methods The clinical data of 48 patients with recurrent renal calculi complicated with upper ureteral stenosis admitted from August 2009 to August 2012 were retrospectively analyzed. There were 20 males and 28 females, ranging in age from 22 to 61 (35.7 ± 11.8) years. Patients had kidney, renal pelvis or upper ureter surgery or treatment history, postoperative residual or recurrence of stones. Hydronephrosis with a depth of 1.0 to 8.0 (2.5 ± 1.1) cm. Combined stones diameter 0.4 ~ 3.5 (1.2 ± 0.7) cm. Ureteral stenosis length of 0.3 to 2.0 (0.8 ± 0.4) cm. Application of percutaneous nephrolithotracheal lithotripsy in the treatment of kidney stones, combined with the use of antegrade balloon dilation in the treatment of upper ureteral stenosis. The rates of stone clearance, changes of hydronephrosis and complications were compared. The results of IVU and CT urography before and after surgery were compared. Results 45 cases (93.8%) of the successful establishment of percutaneous renal access, 3 cases of open surgery. 4 cases (8.3%) had postoperative renal hemorrhage, 3 cases were given superselective renal artery embolization to stop bleeding, 1 case was given nephrectomy, 3 cases (6.2%) had perineal organ injury, 2 cases received conservative treatment and 1 case received open surgery example. Forty-four patients with successful surgery were followed up for 6 to 42 months (20.3 ± 4.2) months. Follow-up B-scan and CT showed clear stones, hydronephrosis significantly reduced or alleviated in 37 cases, IVU or CTU showed no obvious visualization of ureteral stricture; hydronephrosis no significant change in 7 cases. The total effective rate was 84.1% (37/44). Conclusion Percutaneous nephrolithotomy with pneumatic lithotripsy and balloon dilation is effective in treating recurrent nephrolithiasis with upper ureteral stenosis. The patient has less pain and quick recovery after operation.