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目的:探讨输尿管上段结石并重度肾积水的经皮肾治疗方法。方法:经皮肾镜治疗输尿管上段结石并重度肾积水26例。10例直接经皮肾穿刺建立通道行经皮肾镜手术(顺行法)。16例先逆行置输尿管镜达输尿管上段,将输尿管导管绕过结石插入肾盂,再经皮肾穿刺建立通道行经皮肾镜手术(逆行法)。结果:逆行法组均成功找到肾盂输尿管连接部,平均手术时间(2.05±0.12) h;顺行法组平均手术时间为(2.81±0.23) h,2 例因术中未找到肾盂输尿管连接部而行改行体外冲击波碎石治疗。结论:逆行法是经皮肾镜治疗输尿管上段结石并重度肾积水较好的方法,特别是适合于初学者。
Objective: To investigate the percutaneous renal treatment of upper ureteral calculi and severe hydronephrosis. Methods: Percutaneous nephrolithotomy for upper ureteral calculi and severe hydronephrosis in 26 cases. Ten cases of direct percutaneous nephrostomy were established percutaneous nephrolithotomy (cis method). 16 cases of retrograde ureteroscopic ureteroscopic ureteroscopy, the ureteral catheter around the stone inserted into the renal pelvis, and then percutaneous nephrostomy percutaneous nephroscopy (retrograde). Results: In the retrograde group, the ureteropelvic junction was successfully found, with an average operation time of 2.05 ± 0.12 h. The mean operation time of the cisplatin group was (2.81 ± 0.23) h. Two patients had no ureteropelvic junction Shixin extracorporeal shock wave lithotripsy treatment. Conclusion: The retrograde method is a better method of percutaneous nephrolithotomy in the treatment of upper ureteral calculi and severe hydronephrosis, especially for beginners.