經皮腎微造瘺氣壓彈道碎石聯合體外沖擊波碎石治療上尿路結石

[摘要] 目的 探討提高上尿路結石碎石成功率的微創治療方法。方法 采用經皮腎穿微造瘺輸尿管鏡氣壓彈道碎石,術中放置雙J管,術后配合體外沖擊波碎石術(ESWL)治療上尿路結石96例。結果 結石總排凈率為89.1%,結石最小排凈率79.2%,無嚴重并發癥發生。結論 該方法結石排凈率高,創傷較小,手術并發癥少,是上尿路結石較為理想的微創治療方法。

[關鍵詞] 上尿路結石;經皮腎微造瘺;氣壓彈道碎石術;體外沖擊波碎石術

[中圖分類號] R691.4[文獻標識碼] A[文章編號] 1004-8650(2009)06-015-02

Percutaneous renal puncture and pneumatic ballistic lithotripsy combi ned with ESWL in the treatment of the caluculus of upper urinary tract

WEN Wei-jun1,SHI Yu-qiang1,CAO Zhao-hui1, et al.

(Deparment of Urology,The Hospital of Combination of Chinese Traditional and WESTERN Medicine of shunde,Foshan,Guangdong 528333,China)

[Abstract] Objective To investigate the minimally invasive therapeutic method in the successful rate of lithotrispy of calculus of upper urinary tract. Methods 96 cases with calculus of upper urinary tract were treated by percutaneous micro-nephrostomy and ureteroscopic pneumatic ballistic lithotripsy.The double J tube was put during operation and the ESWL was combined after operation.Results Total evacuation rate of stone was 89.1%. No major complications were found af ter operation.Conclusion This method has a high evacuative rate of stone,minor injury and less operative complications.It is an ideal manimally invasive method in the treatment of the calculus of upper urinary tract.

[Key words] calculus of upper urinary tract; pereutaneous renal puncture; pne umatic ballistic lithotripsy; extracorporeal shock were lithotripsy

經皮腎鏡術是腔內泌尿外科手術的一個重要組成部分。近年來,隨著腔內手術設備日益完善及微創外科技術的不斷提高,國內外許多學者正不斷尋求一種療效確切、創傷小、并發癥少的治療上尿路結石的方法。我們自2002年1月-2008年12月應用經皮腎穿輸尿管鏡氣壓彈道碎石聯合ESWL治療上尿路結石96例,取得較好效果,現報告如下:

1臨床資料

1.1一般資料

本組96例,男54例,女42例,年齡18-68歲,平均40歲。左側腎結石50例,右側腎結石30例,左輸尿管上段結石10例,右輸尿管上段結石6例,結石大小(2.0cm×2.2cm)-(3.0×4.8cm)。其中16例接受過ESWL治療,10例曾行開放手術。常規靜脈腎孟造影(IVU)示20例腎臟不顯影,76例腎臟顯影不同程度延遲。腎積水輕-中度者72例,重度積水者24例。逆行造影示輸尿管下段狹窄10例。

1.2手術方法

取持續硬脊膜外腔阻滯麻醉。先取截石位,患側輸尿管逆行插入F5-6輸尿管導管并留置,退鏡后留置導尿管。再俯臥位,穿刺點取腋后線與第12肋交界處或第11肋間向中盞穿刺,還可以從第12肋下向上、下盞穿刺并作二通道。……