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目的:探讨经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄的安全性及疗效。方法:对31例患者采用标准通道经皮肾镜超声气压弹道碎石联合钬激光内切开治疗。31例患者为医源性输尿管上段狭窄伴结石23例,先天性肾盂输尿管交界处狭窄伴结石8例;并发输尿管上段结石11例,肾结石20例。结果:31例无一例中转开放,平均手术时间(62.6±8.6)min,恢复进食时间(32±6)h,下床活动时间(3.2±1.2)d。合并输尿管结石患者均予结石取净,肾结石患者2例下盏残留8mm结石,结石取净率为93.5%(29/31)。术后并发症4例,并发症发生率12.9%,术后并发出血1例,予超选择肾动脉栓塞止血治愈,感染2例,予敏感抗菌素控制,双J管移位1例,予输尿管下调整位置。术后3～6个月复查,肾积水改善总有效率87.1%(27/31),4例肾积水无明显变化。随访6～36个月,2例出现腰部酸胀、积水加重症状,予逆行输尿管镜下钬激光内切开+球囊扩张后好转,1例反复感染肾积水加重予肾切除。结论:经皮肾镜超声气压弹道碎石联合钬激光内切开治疗肾输尿管上段结石伴狭窄结石清除率高、创伤小、手术安全有效。
Objective: To investigate the safety and efficacy of percutaneous nephrolithotracheal pneumatic lithotripsy and holmium laser in the treatment of upper ureteral calculi with stenosis. Methods: Thirty-one patients were treated with standard-channel percutaneous nephroscope, pneumatic lithotripsy and holmium laser. Twenty-one patients were iatrogenic upper ureteral stricture with calculi in 23 cases, congenital ureteropelvic junction stricture with calculi in 8 cases, 11 cases with upper ureteral calculi and 20 cases with renal calculi. Results: None of the 31 cases were open to the public. The average operation time was 62.6 ± 8.6 min, the recovery time was 32 ± 6 h, and the ambulation time was 3.2 ± 1.2 d. Patients with ureteral calculi were taken to remove stones, 2 cases of patients with kidney stones residual light 8mm stones, stone removal rate was 93.5% (29/31). Postoperative complications in 4 cases, the complication rate was 12.9%, postoperative bleeding in 1 case, to super-select renal artery embolization to stop bleeding, infection in 2 cases, to sensitive antibiotics, double J tube shift in 1 case, under the ureter Adjust position. 3 to 6 months after the review, the total effective rate of hydronephrosis improved 87.1% (27/31), 4 cases of hydronephrosis no significant change. Follow-up 6 to 36 months, 2 cases of soreness of the waist, hydrocephalus aggravating symptoms, retrograde ureteroscopic holmium laser incision + balloon dilatation improved, 1 case of repeated infection of hydronephrosis aggravated to the nephrectomy. Conclusion: Percutaneous nephrolithotracheal pneumatic lithotripsy combined with holmium laser endotracheal lithotripsy is a safe and effective method for the treatment of upper ureteral calculi with stenosis stones.