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目的探讨斜仰卧截石位微创经皮肾镜取石术(MPCNL)联合输尿管镜治疗双J管滞留的可行性及疗效。方法双J管滞留合并附管壁结石12例,其中合并患侧肾结石3例。10例患者采用腰硬联合椎管内阻滞麻醉,2例行气管内插管全麻。先取截石位输尿管镜下处理膀胱及输尿管结石,后取患侧垫高向健侧倾斜30～45°体位,在B超定位下作肾穿刺,建立经皮肾取石微通道,肾镜下气压弹道碎石取石,彻底碎石后取出双J管。结果 12例均一期顺利完成手术,平均手术时间(132±24)min。术中大出血1例,留置肾造瘘管压迫,出血自行停止;无胸膜损伤、肠损伤及肾周围其他脏器损伤等并发症发生。结论斜仰卧位合并截石位下行经皮肾镜联合输尿管镜治疗双J管滞留,效果良好,并发症少,取出双J管时可一并取出结石。
Objective To investigate the feasibility and curative effect of minimally invasive percutaneous nephrolithotomy (MPCNL) combined with ureteroscopy in the treatment of double J tube detention. Methods Double J tube retention with tube wall stones in 12 cases, of which 3 cases of ipsilateral kidney stones. Ten patients were treated with spinal combined with spinal block anesthesia and two with endotracheal intubation. First take the lithotomy ureteroscopic treatment of bladder and ureteral calculi, take the affected side of the pad to the healthy side tilted 30 to 45 ° position, in the B-positioning for renal puncture, the establishment of percutaneous nephrolithotracheal microcirculation, pneumatic renal pelvis ballistic broken Stone stone, remove the double-J tube after gravel. Results All the 12 cases completed the operation smoothly with the average operation time (132 ± 24) min. Intraoperative bleeding in 1 case, indwelling renal fistula oppression, bleeding to stop; no pleural injury, intestinal injury and other organs around the kidney injury and other complications occurred. Conclusion Oblique supine combined lithotomy position percutaneous nephroscope combined with ureteroscopy treatment of double J tube retention, the effect is good, less complications, remove the double J tube can be removed with stones.