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目的:评价顺行输尿管软镜碎石术治疗各种尿流改道后上尿路结石的临床应用价值、安全性及疗效。方法:2009年1月～2012年2月采用顺行输尿管软镜碎石术治疗尿流改道后上尿路结石患者19例,其中左侧13例,右侧5例,双侧1例;输尿管结石12例,肾结石5例,同时合并肾结石和输尿管结石2例。4例采用C臂X线引导,15例采用B超引导肾造瘘。11例一期行经皮肾造瘘+顺行输尿管软镜碎石术;8例合并感染及急性梗阻患者一期行经皮肾造瘘,1周后二期行输尿管软镜碎石术。结果:19例患者均取得手术成功,平均手术时间为(61±21)min,平均住院时间为(5.6±3.2)d,术中出血量均<50ml,术中及术后均未发生严重并发症。17例经历一次碎石程序即完全清除,2例经过2次碎石程序。术后4周复查CT,仅1例显示肾盂残留小片状结石,一期结石清除率达94.7%。平均随访15个月,2例患者复发,显示结石复发率为10.5%(2/19),1例经过ESWL得到成功治疗,另1例再次顺行输尿管软镜碎石治疗成功。结论:顺行输尿管软镜是处理尿流改道后上尿路结石治疗的首选方式,具有安全性高、手术成功率高、结石清除率高、复发率低、并发症少等优点,值得临床推广应用。
Objective: To evaluate the clinical value, safety and efficacy of anterograde ureteroscopic lithotripsy in the treatment of various upper urinary tract stones after urinary diversion. Methods: From January 2009 to February 2012, 19 patients with upper urinary tract stones after urinary diversion were treated by anterograde ureteroscopic soft lithotripsy. There were 13 cases on the left side, 5 cases on the right side and 1 case on both sides. Ureter 12 cases of stones, 5 cases of kidney stones, combined with kidney stones and ureteral stones in 2 cases. 4 cases using C-arm X-ray guidance, 15 cases using B-guided renal fistula. One case received percutaneous nephrostomy plus cisternoscopic soft lithotripsy in 11 cases. One case received percutaneous nephrostomy in 8 cases with complicated infection and acute obstruction. One case received ureteroscopic lithotripsy after one week. Results: All the 19 patients achieved successful operation. The average operation time was (61 ± 21) min and the average length of hospital stay was (5.6 ± 3.2) d. The intraoperative blood loss was less than 50ml. No severe intraoperative and postoperative complications occurred disease. Seventeen patients underwent a gravel procedure that was completely cleared and two patients underwent two gravel procedures. 4 weeks after the review of CT, only 1 case showed pelvic residual renal pelvis, a stone clearance rate of 94.7%. The patients were followed up for an average of 15 months. Two patients relapsed. The recurrence rate was 10.5% (2/19). One patient was successfully treated with ESWL and the other was successfully treated with ureteroscopic lithotripsy. Conclusions: Anterograde ureteroscopy is the first choice for the treatment of upper urinary tract stones after urinary diversion, which has the advantages of high safety, high operation success rate, high stone clearance rate, low recurrence rate and few complications. It is worthy of clinical promotion application.