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目的:探索复杂难治的肾及输尿管结石,采用特殊侧卧截石体位,利用腔镜技术,同步会师式治疗的可能性。方法:对5例复杂性肾结石患者,采用斜侧45°卧位,患侧下肢伸直或屈曲固定于脚架上,对侧下肢屈曲外展固定于手术床旁的支架上。行经皮肾镜,碎除肾盂结石后,顺行进入输尿管,同时经尿道置入输尿管镜,在上下导丝及输尿管镜光源的引导下,上下共同前进,碎石或切开狭窄段,直至上下输尿管镜会师。结果:5例患者均手术成功,无一例中转开放,术后复查腹部平片,1例肾盏残余结石直径0.6 cm,术后自行排出。输尿管狭窄患者拔除双J管后1个月复查,输尿管通畅,肾脏无积水。结论:采用特殊侧卧截石体位,同时在输尿管镜及经皮肾镜下,进行上下会师式手术,对于肾结石并输尿管长段石街和结石手术后输尿管长段狭窄等复杂结石患者,完全利用腔镜技术进行治疗,是安全可行的。
Objective: To explore the complex intractable renal and ureteral calculi, the use of special lateral lithotomy position, the use of endoscopic techniques, the possibility of synchronized instrumental therapy. Methods: Five patients with complex renal calculus were treated with oblique 45 ° lying position. The lower extremity was straightened or flexed on the tripod. The contralateral flexion and extension of the lower limb was fixed on the stent beside the operation bed. Percutaneous nephrolithotomy, renal pelvis after the removal of stones, the anterograde into the ureter, ureteroscopic transurethral ureteroscopy at the same time, guided by the upper and lower guide wire and ureteroscope light source, go up and down together, gravel or incision stenosis up and down Ureteroscopy will be division. Results: All the 5 patients were operated successfully. None of the patients were transferred to open surgery. One case of calyceal residual calculus had a diameter of 0.6 cm. After operation, it was discharged spontaneously. Patients with ureteral stricture removed double J after 1 month review, ureteral patency, no water in the kidney. CONCLUSIONS: Special side-lying lithotomy position is used. At the same time, under ureteroscopy and percutaneous nephrolithotomy, upper and lower masseteric surgery is performed. For patients with complicated stones such as kidney stone and ureteral long stone street and ureteral long-stenosis after stone operation, The use of endoscopic techniques for treatment is safe and feasible.