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

摘要

Objective To investigate the safety and efficacy of percutaneous nephrolithotomy ( PCNL ) combined with ureteroscopy in supine anterolateral lithotomy position for the management of complicated upper ureteric calculi . Methods From January 2009 to October 2012, 67 patients underwent PCNL combined with ureteroscopy in supine position under general anesthesia . Renal calculi was treated with PCNL , and then ureteroscopy was used to break and wash out the residual calculi . Results All the 67 surgeries were completed successfully .Operation time was 46 -106 min ( average, 76 min); stone clearance rate was 92.5%(62/67);residual stone was found in 5 cases and were completely removed two weeks after ESWL .No massive hemorrhage , ureteral avulsion, pleura, abdominal organ injury or other complications occurred . Conclusions PCNL combined with ureteroscopy in supine anterolateral lithotomy position for the treatment of complicated upper ureteric calculi is safe and effective .It has shorter operative time and is convenient for the patients .%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。