经皮肾镜联合顺行输尿管软镜在输尿管结石中的应用

目的:探讨经皮肾镜联合顺行输尿管软镜在输尿管结石中的应用价值。方法:回顾性分析2017年1月—2020年9月在泰州市人民医院行经皮肾镜联合顺行输尿管软镜治疗输尿管结石30例患者的临床资料,其中17例输尿管上段结石行经皮肾镜手术过程中结石或残石滑入输尿管中下段,4例输尿管下段结石周围息肉或肉芽组织包裹,3例输尿管结石合并输尿管下段狭窄,2例输尿管结石合并重度前列腺增生,2例既往因膀胱癌行输尿管腹壁造口术,1例既往因膀胱癌行回肠膀胱术(bricker术),1例既往因输尿管下段狭窄行输尿管膀胱再植术。结果:手术时间47～145 min,平均(77±21) min。1例患者出现出血,经介入栓塞后完全恢复;2例患者术后出现高热,加强抗感染后痊愈;其余患者均未出现严重并发症。术后第4～6天复查KUB均未见明显结石残余、双J管位置全部正常。结论:经皮肾镜联合顺行输尿管软镜治疗复杂输尿管结石具有疗效好、安全性高、恢复快等优点,值得临床推广。     

输尿管镜联合经皮肾镜治疗滞留双J管哑铃状附壁结石6例报告

目的：总结输尿管镜联合经皮肾镜治疗滞留双J管哑铃状附壁结石的手术策略和技巧,评价临床疗效。方法：回顾性分析我院2001年2月-2010年7月应用输尿管镜联合经皮肾镜钬激光治疗长期留置双J管后形成哑铃状附壁结石并拔除双J管6例患者的疗效。结果：6例手术均获成功,所有滞留的双J管和合并结石均获得成功处理,术后出现中度血尿3例,高热4例,结石残留1例。结论：联合采用输尿管镜和经皮肾镜结合钬激光碎石处理滞留双J管哑铃状全程附壁结石安全、有效,术后预防尿路感染是重点。     

斜仰卧截石位经皮肾镜联合输尿管镜治疗双J管滞留12例

目的探讨斜仰卧截石位微创经皮肾镜取石术（MPCNL）联合输尿管镜治疗双J管滞留的可行性及疗效。方法双J管滞留合并附管壁结石12例,其中合并患侧肾结石3例。10例患者采用腰硬联合椎管内阻滞麻醉,2例行气管内擒管全麻。先取截石位输尿管镜下处理膀胱及输尿管结石,后取患侧垫高向健侧倾斜30～45°体位,在B超定位下作肾穿刺,建立经皮肾取石微通道,肾镜下气压弹道碎石取石,彻底碎石后取出双J管。结果12例均一期顺利完成手术,平均手术时间（132±24）min。术中大出血1例,留置肾造瘘管压迫,出血自行停止;无胸膜损伤、肠损伤及肾周围其他脏器损伤等并发症发生。瞎论斜仰卧位合并截石位下行经皮肾镜联合输尿管镜治疗双J管滞留,效果良好,并发症少,取出双J管时可一并取出结石。     

斜仰卧截石位经皮肾镜联合输尿管镜治疗双J管滞留12例观察

目的 探讨斜仰卧截石位微创经皮肾镜取石术(MPCNL)联合输尿管镜治疗双J管滞留的可行性及疗效.方法 双J管滞留合并附管壁结石12例,其中合并患侧肾结石3例.10例患者采用腰硬联合椎管内阻滞麻醉,2例行气管内插管全麻.先取截石位输尿管镜下处理膀胱及输尿管结石,后取患侧垫高向健侧倾斜30°～45°体位,在B超定位下做肾穿刺,建立经皮肾取石微通道,肾镜下气压弹道碎石取石,彻底碎石后取出双J管.结果 12例均一期顺利完成手术,平均手术时间(132±24) min.术中大出血1例,留置肾造瘘管压迫,出血自行停止;无胸膜损伤、肠损伤及肾周围其他脏器损伤等并发症发生.结论 斜仰卧位合并截石位下行经皮肾镜联合输尿管镜治疗双J管滞留,效果良好,并发症少,取出双J管时可一并取出结石.     

输尿管镜气压弹道碎石术治疗输尿管结石154例

目的探讨输尿管镜气压弹道碎石术的疗效。方法 2006年3月~2010年3月,输尿管结石154例,腰麻联合硬膜外麻醉,取截石位,输尿管镜在F4导管引导下进入输尿管,到达结石部位后,直视下气压弹道碎石探针(德国Storz公司,1 mm)原位碎石,直径3 mm的结石取出或放入膀胱,小结石冲入膀胱,然后于输尿管内置入双J管,留置尿管。结果手术时间30~120 min,平均50 min。一次碎石排净率96.1%(148/154);4例输尿管结石部分上行入肾盂,输尿管镜碎石术后2周,配合ESWL1~2次,14~30 d结石排净;2例因输尿管下段狭窄输尿管镜无法通过转开放手术。无输尿管穿孔和输尿管黏膜剥脱。152例双J管拔除后随访3个月,KUB+IVU提示149例原结石影消失,肾积水消失,肾功能完全恢复,无结石残留及复发,无输尿管继发性狭窄;3例术前患侧肾、输尿管均不显影者仍有轻度积水,患侧肾显影,肾功能明显恢复。结论输尿管镜气压弹道碎石术治疗输尿管中下段结石、部分ESWL难处理的结石、ESWL术后石街形成有一定的优势。     

利用输尿管软镜处理双J管拔除困难的方法

目的:探讨利用输尿管软镜处理双J管拔除困难的方法。方法:回顾性分析我院2013年6月～2017年5月收治的输尿管双J管拔除困难患者6例,其中男2例,女4例;年龄35～65岁,平均42岁;上尿路结石手术后长期滞留双J管3例,留置双J管时间分别为2个月、8个月、2年,3例双J管上布满结石,无法行膀胱镜取出,予行输尿管镜下钬激光碎石术,击碎附着在双J管上的结石,在输尿管上段将双J管烧断,改用输尿管软镜,在肾盂内将近端双J管上附着的结石击碎,用套石篮将残端双J管取出。另3例患者因肾盂结石拟行输尿管软镜手术,术前留置双J管行输尿管预扩张,双J管留置时间2周,在输尿管软镜术前拔除双J管时发现双J管被肾盂结石卡住无法拔除,予输尿管镜下用钬激光在肾盂出口位置烧断双J管,更换输尿管软镜行输尿管软镜钬激光碎石术,击碎结石后用套石篮取出残留双J管。结果:6例患者均顺利完成手术,无出血,无输尿管损伤,术后再次留置双J管,2～4周后拔除,无结石残留,随访1～2年,无输尿管狭窄。结论:双J管嵌顿后先用钬激光在近端将其烧断,再用输尿管软镜取出残端,可有效避免输尿管损伤。     

顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管复杂病变

目的:探讨经皮肾通道顺行输尿管软镜治疗输尿管中下段结石合并远端输尿管狭窄、扭曲患者的有效性及安全性。方法:回顾性分析2014年6月～2018年11月在我院行输尿管硬镜碎石术(URL)的27例输尿管中下段结石的临床资料,术中发现输尿管狭窄及扭曲严重,输尿管镜难以上行至结石处,改行俯卧位建立F24皮肾镜通道后,顺行置入输尿管导引鞘及输尿管软镜,处理结石。结果:手术时间46～139 min,平均(67±15)min,26例采用顺行输尿管软镜将输尿管结石全部清除(残石颗粒冲入膀胱),术后1～3d拔除尿管,后自行排出,均未出现气胸、肠道损伤、严重出血及输尿管脱套等严重并发症。1例改行开放取石。结论:顺行输尿管软镜在URL治疗失败的输尿管中下段结石合并远端输尿管狭窄、扭曲的治疗中,具有安全、有效、并发症少等优点。     

斜仰卧截石位经皮肾镜联合输尿管镜治疗双J管滞留致全程附壁结石5例报告

目的探讨斜仰卧截石位经皮肾镜联合输尿管镜治疗双J管滞留致全程附壁结石的安全性及可行性。方法斜仰卧截石位,经尿道输尿管镜下钬激光击碎双J管膀胱段结石和输尿管内双J管附壁结石,经皮肾镜钬激光碎石术处理肾盂段双J管附壁结石和肾内新发结石。结果 5例均一期完成碎石并完整取出双J管,无一例术中改开放手术。手术时间平均65 min(40~130 min),术中无严重肾脏出血,无输尿管穿孔及撕脱。术后2例发热,无尿脓毒血症性休克发生。5例随访3~6个月,未见结石复发及输尿管狭窄形成。结论斜仰卧截石位经皮肾镜联合输尿管镜钬激光碎石术治疗双J管滞留致全程附壁结石安全、有效,值得临床推广。     

顺行输尿管软镜在复杂上尿路疾病诊治中的应用

目的探讨顺行输尿管软镜在复杂上尿路疾病中的应用价值。方法 2007年1月～2010年7月应用顺行输尿管软镜诊治上尿路疾病23例,其中联合经皮肾镜诊治复杂性肾结石17例（1例伴上盏憩室结石）,膀胱癌尿流改道后梗阻性疾病3例,后腹腔镜下输尿管切开取石术中输尿管软镜明确结石移位2例,诊断性质不明输尿管病变1例。结果 17例复杂性肾结石经皮肾镜下联合输尿管软镜镜检、碎石,结石清除率100%,术后4周复查KUB无结石残留,无术后并发症。3例输尿管肠段吻合口狭窄,狭窄环内切开扩张、输尿管结石碎石1例,术后6周软膀胱镜下经回肠代膀胱拔除双J管,拔管后3个月随访患侧肾积水无加重。2例后腹腔镜下输尿管上段结石切开取石术中结石移位,输尿管软镜镜检明确结石移行入肾盂,改开放手术治疗。1例尿道损伤闭锁膀胱长期造瘘术后,输尿管软镜下活检明确输尿管癌。结论顺行输尿管软镜诊断和治疗上尿路疾病是一种有效的、微创的方法,在复杂性肾结石、输尿管上段结石的联合诊治、尿流改道后并发症的治疗及输尿管病变的诊断和治疗中是安全的、实用的。     

输尿管镜气压弹道治疗输尿管结石260例临床分析

目的 探讨输尿管镜气压弹道碎石术治疗输尿管结石的疗效.方法 回顾性分析2006年10月～2012年10月260例输尿管结石采用输尿管镜联合气压弹道碎石术治疗的临床疗效.结果 244例碎石成功或取出,成功率93.8％.其中上段结石成功率75.9％(41/54),中下段为98.5％(203/206).25例进镜困难,采用镜体旋转、变换角度,经扩张以及调整体位后入镜成功.13例结石上移入肾盂,置入双J管后行体外冲击波碎石术.3例因严重输尿管狭窄转开放手术.结论 输尿管镜联合气压弹道碎石治疗输尿管结石手术效果好,尤其是中下段结石,对于输尿管镜进镜困难,需要一定技术要求,必要时改开放手术.     

经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石(附78例报告)

目的探讨经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石的安全性和有效性。方法 2007年8月～2009年3月,采用经皮肾镜联合输尿管镜一期治疗78例输尿管结石合并肾结石。其中一侧输尿管结石合并另一侧肾结石24例,双侧输尿管结石合并一侧肾结石8例,单侧输尿管结石合并同侧肾结石46例。结果 78例均一期成功碎石。无严重并发症发生。手术时间40～200min(平均105min),术中出血30～400ml(平均90ml),术后住院时间6～10d(平均7d)。结石清除率91.1%(71/78),3例残余结石直径≥0.6cm,体外冲击波碎石治疗,4例残余结石直径0.6cm,口服药物排石。78例均随访3个月,复查彩超无明显结石残留。结论经皮肾镜联合输尿管镜一期治疗输尿管结石合并肾结石效率高,创伤小,残石率低,并发症少,安全可行。     

Transurethral ureteroscopic removal of ureteral calculi

Rigid ureteroscopy was used for transurethral removal of ureteral stones. Calculi were extracted under direct vision using flexible grasping forceps or a stone basket. If the size of the stone precluded the use of these techniques, we disintegrated the stone using an electro-hydraulic lithotriptor (EHL) or ultrasonic lithotriptor (USL). Between January, 1985 and October, 1985, 35 ureteroscopic procedures were performed for removal of ureteral stones. In 27 cases (77%) the stone was removed successfully. All stones could be removed in mid and lower ureter. However, in upper ureter, the success rate was only 50%. In 8 instances, ureteroscopy failed to remove the ureteral calculus and 6 underwent percutaneous nephrolithotomy, 2 open surgery. Of the ureteral stones, 12 were removed with grasping forceps or a basket manipulation. EHL and USL were used successfully to remove calculi in 15 cases. To make smooth passage of the ureteroscope, a 6F UPJ occlusion balloon catheter was introduced into the ureter and the balloon was inflated in the intramural ureter for 24 hours preoperatively. We have found this to be a useful procedure for smooth passage of the ureteroscope. Most common complication of ureteroscopic stone removal was fever (29%). In 1 case, the ureter was penetrated by the scope. The patient was treated with an indwelling ureteral catheter for 2 weeks. After the catheter was removed, an excretory urogram demonstrated normal ureter without extravasation or obstruction. We conclude that ureteroscopic stone removal can be done safely with careful passage of the scope and careful manipulation of calculi.     

微创经皮肾镜联合输尿管软镜治疗嵌顿性输尿管上段结石

目的探讨超声引导微创经皮肾镜（MPCNL）联合输尿管软镜治疗嵌顿性输尿管上段结石的效果。方法 2009年6月～2011年5月,对25例嵌顿性输尿管上段结石行MPCNL钬激光碎石取石术,其中8例术中观察到〉0.5 cm结石冲入输尿管远端,输尿管软镜从薄壁鞘管置入处理输尿管中下段碎石。结果手术时间50～105 min,平均75 min。结石全部清除（1例输尿管中段残留0.4 cm结石,辅以尿石通药物治疗1个月排净）,均未输血或出现其他严重并发症。结论 MPCNL联合输尿管软镜取石术治疗嵌顿性输尿管上段结石具有损伤小、结石清除率高等优点。     

Ureteroscopic treatment of ureteral lithiasis with pneumatic lithotripsy: analysis of 287 procedures in a public hospital

Ureteroscopes and different lithotripsy methods have greatly improved the urologists ability to treat ureteral stones, regardless of their location in the ureter. We retrospectively reviewed our experience with ureteroscopic pneumatic lithotriptor in 287 patients with ureteral calculi. Ureteroscopic stone treatment was performed between October 1999 and May 2004. Of 221 patients with distal ureteral calculi, 209 (group 1), and 58 of 66 patients with upper ureteral calculi (group 2) were treated successfully by ureteroscopy alone. In group 1, seven migrated stones (to the upper urinary tract) were successfully treated by ESWL later. There were five-treatment failures due to ureteral perforation which consequently required open ureterolithotomy. In group 2, there were five patients with migrated stones; two of them were sent to a percutaneous nephrolithotomy center because of previously unsuccessful ESWL attempts. Three of these with migrated stones were treated by ESWL later. In three patients, we switched to open ureterolithotomy because of ureteral rupture that required surgical repair. Ureteroscopic pneumatic lithotripsy is a safe and effective treatment modality for ureteral calculi.     

Results of percutaneous endoscopic ureterolithotomy compared to that of ureteroscopy

Percutaneous endoscopic ureterolithotomy is not a well-known method for the treatment of impacted ureteral stones. The authors performed a retrospective study to compare the effectiveness of this procedure to ureteroscopy for the treatment of ureteral calculi. Impacted ureteral stones were removed in 93 patients by percutaneous endoscopic ureterolithotomy (Group 1). In 142 patients, ureteroscopy was performed for the treatment of the ureteral stones (Group 2). The same instruments were used to carry out percutaneous endoscopic ureterolithotomy as were used for percutaneous nephrolithotomy. During these interventions, a direct percutaneous puncture and extraction of the stones was performed. The average diameter of the stones was 11 +/- 4 mm in Group 1 and 7 +/- 2 mm in Group 2. The average operating time was 32 +/- 11 minutes in Group 1 and 41 +/- 29 minutes in Group 2. The average duration of hospitalization following the operations was 7.2 +/- 3.1 days in Group 1 and 3.5 +/- 2.5 days in Group 2. In Group 1, the average time of the operations was significantly lower (p 0.006), and the duration of postoperative hospital stay was significantly higher (p < 0.001), compared to Group 2. In Group 1, retroperitoneal hematoma occurred in 1 patient and prolonged urine leakage was detected in 2 cases, whereas in Group 2, pyelonephritis occurred in 5 patients following the operation. In conclusion, the operating time of percutaneous endoscopic ureterolithotomy is shorter and the rate of complications comparable with that of ureteroscopy. Percutaneous endoscopic ureterolithotomy is suggested for the removal of impacted ureteral stones instead of open surgical ureterolithotomy.     

微创经皮肾镜取石术同期治疗双侧输尿管上段结石的疗效分析

目的：评价微创经皮肾镜取石术（MPCNI,）同期治疗双侧输尿管上段结石的有效性及安全性。方法：回顾性分析我院2005年10月～2009年7月共收治22例双侧输尿管上段结石患者的临床资料,全部患者均行微创经皮肾镜取石术。结果：22例患者（44例侧）一次穿刺成功,17例患者一次取净双侧结石,5例患者术后复查一侧残存肾内结石碎粒,其中4例口服排石药物,一个月后复查结石大部分排空,少量残留。1例患者于术后结合ESWL排净结石,手术结石取净率88．6％。平均手术时间（98．9±24．2）min,术中估计出血量平均（240．5±108．1）ml,术后肾造瘘管留置1～2天,术后平均住院时间（4．8±1．3）天。结论：对于身体条件良好,结石相对容易清除的双侧输尿管上段结石。同期MPCNL是安全有效的。     

标准通道经皮肾镜碎石术治疗肾和输尿管上段结石

目的探讨标准通道经皮肾镜碎石术治疗肾及输尿管上段结石的疗效及安全性。方法 2006年8月～2011年11月对758例肾和输尿管上段结石行经皮肾镜手术,采用瑞士第3代EMS超声气压弹道碎石清石系统,超声引导建立经皮肾通道,对质地一般的结石,直接使用超声碎石杆粉碎后清除,结石较坚硬者,先用气压弹道粉碎,再用超声碎石系统清除结石。放置F7双J管,留置F16肾造瘘管。结果单通道碎石743例,双通道12例,三通道3例。单次取石715例,二次取石43例。双侧结石同时手术12例。结石清除率为88.1%(668/758)。术后发生尿路感染72例(9.5%),出血26例(3.4%),其中行肾动脉超选择性栓塞17例(2.2%),开放手术止血1例,肾切除术1例。双J管未进入膀胱内5例,内镜下调整。702例随访3～45个月,平均14个月,结石复发8例,均为感染性结石,5例再次经皮肾镜手术治疗,放弃治疗3例。结论标准通道经皮肾镜碎石术治疗肾和输尿管上段结石安全有效,具有结石清除率高,并发症少的特点。     

双J管治疗妊娠并输尿管结石所致肾绞痛9例报告

目的：探讨放置输尿管双J管治疗妊娠并输尿管结石所致肾绞痛的疗效及安全性。方法：2008～2012年采用膀胱镜或输尿管镜下放置输尿管双J管治疗妊娠并输尿管结石所致肾绞痛患者9例，观察其疗效。结果：9例患者肾绞痛症状均缓解，且均顺利足月分娩。分娩后，2例结石自行排出，3例行输尿管镜下取石术，3例行ESWL治疗，1例行经皮肾取石术。结论：对于保守治疗不能缓解的妊娠并输尿管结石肾绞痛患者，置人输尿管双J管是一种缓解肾绞痛的安全有效的治疗方法。     

斜仰卧截石位经皮肾镜联合输尿管镜处理输尿管上段复杂结石

目的：探讨斜仰卧截石位经皮肾镜联合输尿管镜处理输尿管上段复杂结石的安全性及有效性。方法2009年1月～2012年10月,采取斜仰卧截石位经皮肾镜联合输尿管镜治疗输尿管上段复杂结石67例,气管插管全麻,先行经皮肾镜处理结石,向下移位结石再行输尿管镜将移位结石碎石并经工作通道冲出。结果67例手术均一次完成,手术时间46～106 min,平均76 min。一次结石清除率92．5％（62/67）,结石残留5例,配合ESWL 2周后结石完全清除。均无大出血、输尿管撕脱、脏器损伤等并发症。结论斜仰卧截石位经皮肾镜联合输尿管镜处理输尿管上段复杂结石具有体位舒适,避免术中体位变换带来的不便,手术时间短,有利于术中麻醉监护,碎石取石效果好,并发症少的优点,治疗的安全性高,值得临床推广。     

Percutaneous chemolitholysis of cystine stone

Although cystine stone accounts for only 1-3% of renal calculi, many of the pure cystine stones usually can not be fragmented by ESWL and the residuals after PCNL is quite common. Percutaneous dissolution alone or combined with ESWL and PCNL could successfully dissolve these stones including all the residuals. This paper reported seven patients (8 pieces of renal and 2 pieces of ureteral stones) with cystine calculi in whom percutaneous renal irrigation or per-ureteral catheter irrigation with tromethamine-E (THAM-E) were performed for a relatively short period of time. All the stones disappeared completely or near completely. The authors recommend that percutaneous irrigation alone (including irrigation with ureteral catheter) or combined with PCNL and ESWL are the method of choice in the treatment of pure cystine stone of the kidney.