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目的:探讨腔镜治疗输尿管末端结石并无功能肾的处理策略。方法:输尿管末端结石并无功能肾9例,术前影像学及尿细胞学检查均未发现肿瘤改变。先以膀胱电切镜经尿道行膀胱袖状切除术,再在B超引导下,经皮细针穿刺抽吸部分肾积水,约1000~2 500 ml,增大后腹腔空间,行后腹腔镜下肾输尿管全切术,最后在下腹部取4~6 cm小切口,将肾、输尿管全长及末端结石完整取出结果:9例患者手术顺利,手术时间150~270min,平均(190.5±23.7)min;估计出血量30~90 ml.平均(54.2±1 3.6)ml;术后7~10天拆线出院。随访6个月~3年,无肿瘤等并发症发生。术后输尿管末端病理检查示:6例慢性炎症;2例慢性炎症并上皮细胞不典型增生;1例输尿管原位癌。结论:输尿管末端结石长期慢性炎性刺激,导致尿路上皮细胞异常增生与癌变。对输尿管末端结石合并无功能肾患者,视同输尿管癌,后腹腔镜联合膀胱电切镜行肾输尿管全长与膀胱袖状切除术,达到微创效果。
Objective: To explore the endoscopic treatment of ureteral calculi and no treatment of renal function. Methods: There were 9 cases of non-functioning kidney with ureteral calculi, and no tumor was found in preoperative imaging and urine cytology. The first resection of the bladder with cystoscopic transurethral resection of the bladder, and then guided by the B, percutaneous fine needle aspiration of hydronephrosis, about 1000 ~ 2 500 ml, increased posterior abdominal space, posterior abdominal Finally, 4 ~ 6 cm small incision was made in the lower abdomen to remove the entire length of the kidney and ureter completely. Results: Nine patients were operated smoothly and the operation time was 150-270 minutes (mean, 190.5 ± 23.7) min; estimated bleeding amount of 30 ~ 90 ml. (54.2 ± 1 3.6) ml; 7 to 10 days postoperative stitches discharged. Follow-up 6 months to 3 years, no complications such as cancer. Postoperative ureteropathological examination showed: 6 cases of chronic inflammation; 2 cases of chronic inflammation and epithelial dysplasia; 1 case of ureteral carcinoma in situ. Conclusion: Long-term chronic inflammatory stimulation of ureteral calculi leads to abnormal proliferation and carcinogenesis of urothelial cells. Ureteral calculi at the end of stones with non-functional renal patients, as ureteral cancer, retroperitoneoscopy and bladder resection of the total length of the ureter and bladder sleeve resection, to achieve minimally invasive results.