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目的探讨经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石的安全性和有效性。方法 2007年8月～2009年3月,采用经皮肾镜联合输尿管镜一期治疗78例输尿管结石合并肾结石。其中一侧输尿管结石合并另一侧肾结石24例,双侧输尿管结石合并一侧肾结石8例,单侧输尿管结石合并同侧肾结石46例。结果 78例均一期成功碎石。无严重并发症发生。手术时间40～200min(平均105min),术中出血30～400ml(平均90ml),术后住院时间6～10d(平均7d)。结石清除率91.1%(71/78),3例残余结石直径≥0.6cm,体外冲击波碎石治疗,4例残余结石直径<0.6cm,口服药物排石。78例均随访3个月,复查彩超无明显结石残留。结论经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石效率高,创伤小,残石率低,并发症少,安全可行。
Objective To investigate the safety and efficacy of percutaneous nephrolithotomy combined with ureteroscopy in the treatment of ureteral calculi combined with kidney stones. Methods From August 2007 to March 2009, 78 cases of ureteral calculi combined with kidney stones were treated with percutaneous nephrolithotomy combined with ureteroscopy. One side of ureteral stones combined with the other side of the kidney stones in 24 cases, bilateral ureteral calculi with kidney stones in 8 cases, unilateral ureteral stones with ipsilateral kidney stones in 46 cases. Results 78 cases of homogeneous gravel. No serious complications occurred. The operation time was 40 ~ 200min (mean 105min), intraoperative bleeding was 30 ~ 400ml (average 90ml), postoperative hospital stay was 6 ~ 10d (average 7d). Stone clearance rate was 91.1% (71/78), 3 cases of residual stone diameter ≥ 0.6cm, extracorporeal shock wave lithotripsy, 4 cases of residual stone diameter <0.6cm, oral drugs row stone. 78 cases were followed up for 3 months, there was no obvious residual ultrasound examination. Conclusion Percutaneous nephrolithotomy combined with ureteroscopy for the treatment of ureteral stones combined with renal stones, high efficiency, small trauma, low residual stone rate, fewer complications, safe and feasible.