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目的 探讨上尿路结石的治疗方法。 方法 对 32 18例上尿路结石患者的临床分类和治疗方法作回顾性分析。本组单纯性肾结石 136 5例 ,复杂性肾结石 6 5 1例。输尿管结石横径 <0 .8cm ,首次肾绞痛发作时间在 1周以内 ,估计结石在输尿管内停留时间 <4周 ,IVU示造影剂可通过结石者 (Ⅰ组 ) 5 5 8例 ;结石横径 >1.0cm ,估计结石停留时间 >4周 ,IVU示有不同程度肾积水者 (Ⅱ组 )4 5 2例 ;结石横径 >1.0cm ,估计结石停留时间超过 6个月 ,有严重肾积水或结石呈锯齿状、结石下方有息肉或输尿管扭曲成角者 (Ⅲ组 ) 192例。 结果 本组手术取石 116 4例 ;ESWL治疗 192 3例 ;输尿管镜直视下碎石 131例。复杂性肾结石手术残余结石 5 7例 (8.8% ) ,行肾切除 12例 (1.8% )。ESWL组 3个月内排石率 81.6 % ,转手术率 18.4 %。输尿管镜下气压弹道碎石效果不佳改行手术取石 8例(6 .1% )。 结论 ESWL、输尿管镜直视下碎石、术中应用气压弹道式碎石或两种以上方法联合应用治疗上尿路结石可减轻患者痛苦或降低手术难度。开放性手术放置内引流可减少术后并发症。ESWL治疗应积极处理石街、控制感染和最大限度减轻医源性肾功能损害。输尿管镜直视下碎石需熟练的内腔镜操作技术。
Objective To investigate the treatment of upper urinary tract stones. Methods The clinical classification and treatment of 32 18 patients with upper urinary tract stones were retrospectively analyzed. 136 cases of simple renal calculi in this group, 651 cases of complex renal stones. Ureteral stones diameter <0.8cm, the first onset of renal colic in less than 1 week, the estimated duration of stones in the ureter <4 weeks, IVU showed contrast agent can pass calculi (Ⅰ group) 558 cases; stone horizontal Diameter> 1.0cm, estimated stone residence time> 4 weeks, IVU showed different degrees of hydronephrosis (group Ⅱ) 452 cases; stone diameter> 1.0cm, the estimated stone residence time of more than 6 months, severe kidney Hydrocephalus or stones were serrated, stones under the polyps or ureter twisted angle (group) 192 cases. Results This group of 1164 cases of stone surgery; 192 cases of ESWL treatment; ureteroscopic 131 cases under gravel. Fifty-seven (8.8%) cases of residual stones were complicated with nephrolithotomy, and 12 cases (1.8%) with nephrectomy. ESWL group within 3 months of stone discharge rate of 81.6%, 18.4% rate of surgery. Ureteroscopic pneumatic lithotripsy ineffective diverting operation in 8 cases (6.1%). Conclusions ESWL, ureteroscopic lithotripsy, intraoperative pneumatic lithotripsy or a combination of two or more methods of treatment of upper urinary tract stones can reduce pain or reduce the difficulty of surgery. Open surgical drainage can reduce postoperative complications. ESWL treatment should be actively treated stone street, infection control and minimize iatrogenic renal damage. Ureteroscopy under the gravel to be skilled endoscopic operating techniques.