特殊侧卧截石体位同步会师式治疗复杂肾及输尿管结石（附5例报告）

目的：探索复杂难治的肾及输尿管结石,采用特殊侧卧截石体位,利用腔镜技术,同步会师式治疗的可能性.方法：对5例复杂性肾结石患者,采用斜侧45°卧位,患侧下肢伸直或屈曲固定于脚架上,对侧下肢屈曲外展同定于手术床旁的支架上.行经皮肾镜,碎除肾盂结石后,顺行进入输尿管,同时经尿道置入输尿管镜,在上下导丝及输尿管镜光源的引导下,上下共同前进,碎石或切开狭窄段,直至上下输尿管镜会师.结果：5例患者均手术成功,无一例中转开放,术后复查腹部平片.1例肾盏残余结石直径0.6 cm.术后自行排出.输尿管狭窄患者拔除双J管后1个月复查,输尿管通畅,肾脏无积水.结论：采用特殊侧卧截石体位,同时在输尿管镜及经皮肾镜下,进行上下会师式手术,对于肾结石并输尿管长段石街和结石手术后输尿管长段狭窄等复杂结石患者.完全利用腔镜技术进行治疗,是安全可行的.

Treatment of Complex Renal and Ureteral Calculi by Combined Ureteroscopy and Nephroscopy Approach in a special Lateral Lithotomy(Report of 5 Cases)

Objective：To evaluate the methods for treatment of complicated urolithiasis in a special lithotomy with right or left lateral tilt by a combined nephroscopy and ureteroscopy approach. Methods： 5 cases of patients with kidney stones were put in a special lithotomy position with 45° lateral tilt, lying on lower limb unbended and buckled to the foot shelf of a surgery bed. Stones in pelvic were crushed by percutaneous nephroscopy lithotripsy, then put the ureteroscope into ureter with a guidewire and stones in the ureteral were lithotripsied, and strictures were cut forward until met the nephroscope. Results：5 cases are treated successfully,with no conversion to open. Showed by postoperative abdominal plain film, one case remained a 0.6 cm stone and was discharged by conservative treatment. According to the ureteropelvic junction atresia case, the double-J was pulled out after a month postoperatively, and the ureter was proved to be unobstructed by intravenous pyelography （IVP） after another month. Conclusions：Lithotomy position using the special side, while ureteroscopy and percutaneous nephrolithotomy, to join forces and clown-type operation for kidney stones and Ureteral Stone Street and stones Oreteral stricture after the operation the complex stone patients, full use of cavity mirror therapy technique is safe and feasible.