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目的:评价经皮肾镜治疗肾结石合并肾盂输尿管连接部狭窄(UPJO)的疗效。方法:肾结石合并UPJO患者36例,男22例.女14例,平均51(4 5～68)岁。单发结石31例,多发结石5例。9例轻度肾积水,25例中度肾积水,2例重度肾积水。经B超、CT、顺行及逆行尿路造影显示结石平均直径2.4(1.2～4.3)cm,UPJO狭窄段平均长度2.0(1.5～3.0)cm;36例均在B超引导下经皮建立肾脏单通道行气压弹道联合超声碎石,并采用自制微小电钩行UPJO狭窄环内切开术。结果:36例肾结石完全清除。33例UPJO狭窄环完全解除,肾积水消失;3例肾积水症状缓解,无进行性增加,仍进行临床随访。全部病例术中术后均无严重并发症发生。36例随访平均24(6～40)个月,经B超、CT、顺行尿路造影检查无肾结石复发,无二次狭窄。结论:采用经皮肾镜单通道一次性治疗肾结石合并UPJO微创、安全、可行,总体疗效满意。
Objective: To evaluate the efficacy of percutaneous nephrolithotomy in the treatment of renal calculi associated with ureteropelvic junction stenosis (UPJO). Methods: Thirty-six patients with renal calculi complicated with UPJO, 22 males and 14 females, average 51 (45-68) years old. 31 cases of single stone, multiple stones in 5 cases. 9 cases of mild hydronephrosis, 25 cases of moderate hydronephrosis, 2 cases of severe hydronephrosis. The mean diameter of stones in the UPJO group was 2.0 (1.5-3.0) cm with B-mode ultrasound, CT, paracentesis and retrograde urography. The average diameter of stones was 2.4 Single-channel pneumatic ballistic combined with ultrasonic lithotripsy, and the use of home-made micro hook UPJO narrow ring incision. Results: 36 cases of kidney stones completely cleared. 33 cases of UPJO stenosis ring completely lifted, hydronephrosis disappeared; 3 cases of hydronephrosis alleviate the symptoms, no progressive increase in clinical follow-up. No serious complications occurred after surgery in all cases. 36 cases were followed up for an average of 24 (6 ~ 40) months. No recurrence of nephrolithiasis was found by B-mode ultrasonography, CT, and urography. No secondary stenosis was found. Conclusion: One-pass percutaneous nephrolithotomy treatment of renal stones combined with UPJO minimally invasive, safe and feasible, the overall effect is satisfactory.