孤立肾上尿路结石微创治疗.docVIP

孤立肾上尿路结石微创治疗 　 作者：孟祥军，李逊，曾国华，何朝辉，何永忠 【关键词】 孤立肾 Minimally invasive treatment of upper urinary tract calculi in a solitary kidney 　　ABSTRACT: Objective To investigate the feasibility and clinical effect of minimally invasive technique in treating upper urinary tract calculi in a solitary kidney. Methods The data of 101 patients with upper urinary tract calculi who underwent minimally invasive treatment were reviewed retrospectively. Of the 101 cases, 13 cases were treated by ESWL, 17 by URL and 71 by mPCNL. Results The stonefree rate of ESWL was 86.9%. The stonefree rate of URL was 100% in patients with middle and lower ureteral calculi, and 76% in patients with ureteral calculi respectively. No ureter perforation and avulsion were noted in the URL group. After mPCNL, the stonefree rate was 94%, and no pelvic perforation and parenchyma laceration were recorded. In 38 cases with acute/chronic renal failure, the serum Cr level decreased from 138-902μmol/L to 55-129μmol/L 3 to 14 days after operation. Conclusion Treatment of upper urinary tract calculi by minimally invasive technique is less invasive, safe and relatively effective, and should be an alternative for upper urinary tract calculi in a solitary kidney. 　　KEY WORDS: solitary kidney; calculi; minimally invasive technique 　　摘要：目的 探讨应用微创技术治疗孤立肾上尿路结石的可行性与临床疗效。方法 从2001年2月至2005年4月，对101例孤立肾上尿路结石的患者采用微创技术治疗，其中体外冲击波碎石术(ESWL)13例，经尿道输尿管镜碎石术(URL)17例,微创经皮肾镜取石术(mPCNL)71例。结果 ESWL组术后结石排净率86.9%；URL组输尿管中、下段结石取净率100%，上段结石取净率为76%，术中无输尿管穿孔和撕脱发生；mPCNL组结石取净率94%，术中未见肾盂穿孔和肾皮质撕裂,术后1例输血，输血率为1.4%。术前38例有急/慢性肾功能不全者，术后3-14d复查，血Cr由138-902μmol/L降至55-129μmol/L。结论 微创技术治疗孤立肾上尿路结石具有微创、安全、效果较好等优点，可作为孤立肾上尿路结石的一种治疗方法。 　　关键词：孤立肾；结石；微创技术 　　孤立肾上尿路结石疾病由于独特的病理生理特点，临床处理较为棘手。我们自2001年2月至2005年4月利用微创技术治疗各种孤立肾上尿路结石101例，疗效满意，现报告如下。 　　1 材料与方法 　　1.1 临床资料 本组101例，男65例，女36例，年龄19-68岁。对侧肾切除39例，对侧肾无功能60例，先天性孤立肾2例。行B超、X线摄片(KUB、IVP、逆行造影)、ECT和CT检查，其中肾结石52例，输尿管中、下段结石11例，输尿管上段结石28例，肾输尿管多发性结石10例。肾结石大小7mm×1.1mm至57mm×28mm，平均大小为27mm×12mm；输尿管结石大小7mm×4mm至30mm×16mm，平均大小为14mm×5mm。