论文部分内容阅读
目的探讨斜卧截石位行经皮肾镜联合输尿管镜处理复杂性输尿管结石的可行性及疗效。方法 2010年10月至2011年12月共68例72侧复杂输尿管结石患者。所有患者采取斜卧截石位,先行超声定位下经皮肾镜术,建立通道并处理结石。随后自尿道行输尿管镜,将剩余结石冲入肾盂自经皮肾镜通道将结石取出。结果 67例71侧碎石取石术均获得成功,术中无严重并发症。手术时间(自穿刺开始至手术结束)15～60min(平均34.3±12.2min)。1例患者输尿管出口及上段狭窄行二期肾切除术,1例先行肾盂穿刺造瘘二期手术患者,发现瘘道在结肠,即行变换穿刺通道手术成功。术后平均住院日6d,结石取净率100%。结论斜卧截石位下行经皮肾镜联合输尿管镜术治疗复杂性输尿管结石安全有效,体位舒适,手术时间短,有利于术中麻醉监护,碎石取石效果好,可作为其微创治疗的首选治疗手段,值得在基层医院中临床推广。
Objective To investigate the feasibility and efficacy of percutaneous nephrolithotomy combined with ureteroscopy in the treatment of complicated ureteral calculi. Methods From October 2010 to December 2011 a total of 68 cases of 72 patients with complicated ureteral calculi. All patients with oblique lithotomy position, the first ultrasound positioning percutaneous nephrolithotomy, the establishment of access and treatment of stones. Followed urethral ureteroscopy, the remaining stones into the renal pelvis from percutaneous renal tunnel will remove the stones. Results 67 cases of 71 lithotripsy were successful, no serious complications during operation. The operation time (from the start of puncture to the end of operation) was 15-60 minutes (average 34.3 ± 12.2 minutes). One case of ureteral exports and the upper stenosis two nephrectomy, one case of second preoperative renal pelvic puncture fistula surgery patients and found the fistula in the colon, that is, the line change the puncture access surgery. The average postoperative hospital stay 6d, stone take rate of 100%. Conclusions The oblique percutaneous lithotomy with descending percutaneous nephrolithotomy combined with ureteroscopy in the treatment of complicated ureteral calculi is safe and effective, with comfortable position and short operative time, which is good for intraoperative anesthesia monitoring and lithotripsy and can be used as minimally invasive treatment Preferred treatment, it is worth the clinical promotion in primary hospitals.