上尿路结石的手术方式选择.docVIP

上尿路结石的手术方式选择 nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp;nbsp; 作者：何俊，徐苗，成泽民，曾东升，杜义堂 【关键词】nbsp; 尿路结石 　　Choice of operation procedures for upper urinary tract calculi(report of 2528 cases) 　　ABSTRACT: Objectivenbsp; To compare the various treatments of upper urinary tract calculi. Methodsnbsp; The data of 2528 patients with upper urinary tract calculi during 1997 to 2004 were analyzed retrospectively. Resultsnbsp; Patients with simple kidney stone and upper ureteral stone were mainly treated with ESWL. The stonefree rate of ESWL was 86%; 5% patients formed stone street, and 9% showed no effects after 2-3 times of ESWL; 14% had to use other methods. Patients with middle or lower ureteral stone were mainly treated with ballistic lithotripsy, and the stonefree rate was 92%. The stonefree rate of PCNL was 100% for pelvic and upper ureteral stone and 95% for staghorn stone. Patients with complicated kidney stone were mainly treated with open surgery or combination of procedures. After operation, 7 cases underment nephrectomy of oneside because dysfunction; 7 developed leakage of urine, 3 chronic difficulttoheal wounds; 5 hemorrhages in kidney, and no one died. Conclusionnbsp; The microinvasive surgery to remove upper urinary tract calculi can avoid pain in patients, and decrease the difficulty of operation and perioperative complications. But the open surgery is still of great use for complicated stone. In all these methods, inflammation and functional lesion should be controlled carefully. 　　KEY WORDS: upper urinary tract calculi; extracorporeal shock wave lithotripsy; ballistic lithotripsy; open surgery; percutaneous nephrolithotomy 　　摘要：目的nbsp; 分析上尿路结石的各种手术方式，探讨临床治疗中合理的术式选择。方法nbsp; 回顾性分析1997年-2004年收治的2528例上尿路结石患者的临床分类、手术方式及并发症。结果nbsp; 单纯性肾结石和输尿管上段结石以ESWL治疗为主，3个月内结石排净率为86%，5%形成石街，9%经2-3次ESWL治疗无排石现象，转手术率14%；中、下段结石采用输尿管镜下气压弹道碎石治疗为主，结石排净率为92%。经皮肾穿肾镜取石，肾盂和输尿管上段结石的取净率为100%；鹿角形结石的取净率为95%；复杂性肾结石选择开放性手术取石或联合方式治疗为主，因肾脏无功能而行一侧肾切除7例(1.6%)，手术后