双镜联合治疗完全重复肾合并输尿管结石探析.docVIP

双镜联合治疗完全重复肾合并输尿管结石探析 　　[摘要] 目的 探讨双镜联合治疗完全重复肾合并双输尿管结石的临床特性及诊疗方法。方法 回顾蒙自市人民医院泌尿外科于2014年5月―2015年9月收治的3例完全重复肾、重复输尿管畸形并双输尿管结石患者的临床资料并进行相关文献复习。 结果 3例患者通过行经皮肾镜联合输尿管镜钬激光碎石一次性完全清除结石，术中术后无并发症，术后4周用取出双J管。 结论 经皮肾镜联合输尿管镜是治疗完全重复肾合并双输尿管结石的一种有效可行的方法，值得临床推广 [关键词] 完全重复肾 重复输尿管畸形；输尿管结石；经皮肾镜；钬激光 [中图分类号] R692.1 [文献标识码] A [文章编号] 1674-0742（2017）03（b）-0186-03 [Abstract] Objective To discuss the clinical features and diagnosis and treatment method of bimirror in treatment of total duplex kidney and ureteral calculus. Methods The clinical data of 3 cases with total duplex kidney and abnormalities duplex kidney and ureteral calculus treated in Mengzi People?s Hospital from May 2014 to September 2015 were retrospectively analyzed and the related literatures were reviewed. Results The stones were totally cleared by one time of the three cases of patients by the spleen kidney mirror and ureteroscopic holmium laser lithotripsy and there were no complications in operation and after operation and the double j tube was taken out in four weeks after operation. Conclusion Spleen kidney mirror and transurethral ureteroscopic lithotripsy is an effective and feasible method in treatment of total duplex kidney and ureteral calculus， which is worth clinical promotion. [Key words] Total duplex kidney abnormalities duplex kidney； Ureteral calculus； Spleen kidney mirror； Holmium laser 完全重?蜕鲋馗词淠蚬芑?形是泌尿外科罕见的先天畸形，大约有一半的患者有合并症，如积水、感染、结石等。部份患者需要手术治疗，传统开放的手术对患者损伤大，该院于2014年5月―2015年9月收治了3例完全重复肾、重复输尿管畸形并双输尿管结石患者，用双镜联合治疗，取得良好效果，现报道如下 1 资料与方法 1.1 一般资料 3例患者，2男1女，年龄为44岁、52岁、36岁，左侧2例，右侧1例，均为单侧完全重复肾输尿管畸形。均因肾绞痛入院。B超检查，两例提示：左侧输尿管上段结石并左肾轻度积水声像；1例提示右侧输尿管上段结石并右肾轻度积水声像。入院后3例给予行血常规、凝功能、免疫功能及尿沉渣肝肾功能检测均未见明显异常，尿培养阴性。胸片心电图检查未见异常。泌尿系CT检查两例提示：1左侧输尿管腹段多发结石，并左肾积水（图1、图2），行kub+ivp： 两例示左侧双肾盂、部分双输尿管畸形，双输尿管腹段结石，双肾分泌排泄功能良好（图3、图4）。1例提示右侧输尿管腹段多发结石，并右肾积水，kub+ivp示右侧双肾盂、部分双输尿管畸形，双输尿管腹段结石 1.2 手术方法 3例患者均采用手术治疗：全麻后，患者取健侧斜卧+膀胱截石位，常规消毒、铺巾，分两组人员操作，一组用输尿管镜从尿道进入患侧输尿管，探查到达输尿管上段，见到上段结石用30 W钬激光碎石，置入5 Fr双J管，考虑是完全重复输尿管，输尿管镜退回膀胱，寻找另一输尿管开