上段输尿管结石的现代微创手术治疗

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1、上段输尿管结石的现代微创手术治疗作者：韩邦【关键词】输尿管结石TheminiinvasivetherapyofupperureteralcaculiHanBangmin,XiaShujie,LuJun,FanJie,SunXiaowen,WenWei,ZhangJie(DepartmentofUrology,ShanghaiNo.lHospital,Shanghai200080,China)ABSTRACT:ObjectiveToinvestigatethetreatmentofupperureteralcalculiwithminiinvasivesurgery

2、.MethodsTheinformationof78casesofupperureteralcalculiwereanalyzed,whichweretreatedbyureteroscopicpneumaticlithotripsyandHo:YAGlaserlithotripsy,minipercutaneousnephrolithotomy(mPCNL),laparoscopicureterolithotomyandopensurgery.Results18of24casesofureteroscopicpneumaticlithotripsyobtaine

3、dsatisfactoryresults,while4casesneededESWLaftersurgery,1stoppedoperationbecauseofbleeding,1changedtoopensurgerybecauseofpartialruptureoftheureteral.Allof16casesofHo:YAGlithotripsyweresuccessful.Inallofureteroscopiclithotripsy,2developedureterperforation,5failedtoreachthestones・27cases

4、ofmPCNLweresuccessfulandnoseverecomplicationsoccurred.3laparoscopicoperationtookoutthestonessuccessfully,noleakageofurineoccurred・ConclusionUreteroscopicpneumaticlithotripsyiseffectivetoremoveupperureteralcalculiandHo:YAGlaserlithotripsyismoreeffective.mPCNLissafeandeffectivetoremoveu

5、pperureteralcalculiespeciallythebigandtoughstones,orthosenearthepelvic.Forthosewhofailedwithotherminiinvasivesurgery,laparoscopicureterolithotomyisaverygoodchoice・KEYWORDS:ureteralcalculi;surgery;ureteroscopiclithotripsy;minipercutaneousnephrolithotomy;laparoscopicureterolithotomy摘要：目

6、的评价各种微创手术方法治疗上段输尿管结石的价值。方法对我院收治的78例上段输尿管结石患者的治疗方法进行回顾性分析。其中经输尿管镜下气压弹道碎石24例，输尿管镜钦激光碎石16例，微创经皮肾输尿管镜取石(mPCNL)27例，后腹腔镜取石3例，开放手术8例。结杲输尿管镜气压弹道碎石18例碎石成功，4例因较大残石行ESWL,1例因黏膜出血视野模糊终止手术,1例输尿管部分断裂改开放手术；钦激光组16例均碎石成功；逆行输尿管镜共有2例输尿管穿孔，均成功放置DJ管，2例因输尿管过度迂曲成”有端”，3例因结右以下输尿管僵硬狭窄无法进镜改开放手术；mPCNL组27例全部取石成功，无

7、严重并发症；后腹腔镜组3例均取石成功，无漏尿发生。结论输尿管镜下碎石是治疗上段输尿管结石的有效手段，钦激光碎石优于气压弹道碎石，可明显提高碎石效率；mPCNL是一种安全、非常有效的治疗方法，对于结石较大、较硬以及靠近肾盂的结右尤为适宜；经腹腔镜取石与上述方法相比，耗吋长、创伤大，但对曾行微创取石失败的患者是一个理想的选择。关键词：输尿管结石；治疗；输尿管镜取石术；经皮肾穿刺取石术；后腹腔镜输尿管切开取石术尿路结石的治疗在近几年来发生了很人变化，开放手术已逐渐被各种微创手术所代替，其中输尿管镜下碎石术已成为治疗中下段结石的首选方法，但对于上段输尿管结石的治疗，输尿管

8、镜却受到许