Clinical application of percutaneous anterograde flexible ureteroscopy in the treatment of special ureteral calculi
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摘要: 目的 探讨经皮肾通道顺行输尿管软镜治疗特殊类型输尿管结石的有效性及安全性。方法 回顾性分析2018年1月—2021年3月上海市静安区闸北中心医院收治的12例特殊类型输尿管结石的临床资料，结石均位于输尿管中下段，其中包括根治性膀胱切除回肠通道术8例、根治性膀胱切除输尿管皮肤造口术2例(其中1例10年前因左侧肾盂癌已行左侧半尿路切除，为功能性孤立肾)、输尿管膀胱再植术后2例(均为逆行输尿管镜无法进镜成功的患者)。患者均采用经皮肾通道顺行输尿管软镜治疗，术后根治性膀胱切除尿流改道患者留置单J管，输尿管膀胱再植患者留置双J管。结果 12例患者中有11例一期顺利完成碎石；1例根治性膀胱切除回肠通道术患者合并肾积脓，一期行肾造瘘，2周后二期行顺行输尿管软镜碎石。12例患者中4例根治性膀胱切除回肠通道术、2例根治性膀胱切除输尿管皮肤造口术和1例输尿管膀胱再植术合并输尿管吻合口狭窄。所有患者术后均未出现严重并发症，手术时间为42~126 min，平均(61.2±10.6) min。术后1~3 d复查腹部平片、泌尿系CT及肾功能，患侧输尿管支架位置均正常，肾积水及肾功能均有不同程度缓解。结论 经皮肾通道顺行输尿管软镜治疗特殊类型输尿管结石具有微创、安全、有效、并发症少、术后恢复快等优点，值得临床推广。Abstract: Objective To evaluate the efficacy and safety of percutaneous nephrolithotomy with anterograde flexible ureteroscope in the treatment of special ureteral calculi.Methods From January 2018 to March 2021, 12 cases of special type ureteral calculi were treated in Zhabei Central Hospital, Jing'an District. All of the calculi were located in the middle and lower part of the ureter, among them, there were 8 cases of ureteral calculi after radical cystectomy and ileal conduit, 2 cases of radical cystectomy for ureterostomy (1 case had left hemi-urethra resection because of left renal pelvis cancer 10 years ago, which was a functional solitary kidney), and two cases of ureteral calculi after replantation of ureter bladder. They were all treated by anterograde ureteroscope. Single J tube was retained in patients with radical cystectomy, while double J tube was retained in patients with ureteral bladder replantation.Results Eleven of the 12 patients were successfully treated with primary lithotripsy. The rest one was found pyonephrosis after radical resection of bladder cancer and ileal conduit, so anterograde flexible ureteroscopic lithotripsy was performed two weeks later. Among the 12 cases, there were 4 cases of radical cystectomy and ileal conduit, 2 cases of radical cystectomy and ureterocutaneostomy and 1 case of ureterolithiasis complicated with anastomotic stricture. No serious complications were found in all patients. The duration of operation was 42-126 minutes, with an average of (61.2±10.6) minutes. The abdominal plain film, urinary CT and renal function were reexamined 1-3 days after operation. The position of ureteral stents was normal. Hydronephrosis and renal function were relieved in different degrees.Conclusion Percutaneous nephrolithotomy with anterograde flexible ureteroscope for special ureteral calculi is a safe and effective treatment with less complications and rapid postoperative recovery. It is worthy of clinical promotion.
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