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目的:研究斜仰截石位输尿管镜联合经皮肾镜治疗复杂性输尿管上段结石的安全性和有效性。方法:2011年2月-2012年2月采用斜仰截石位输尿管镜联合经皮肾镜治疗复杂性输尿管上段结石患者36例,平均年龄(47±15)岁,结石位于左侧20例,右侧16例。结石最大径1.5-3.0 cm,平均(2.0±1.0)cm。该体位摆放完成后患者整体成一斜向截石位。采用连续硬膜外麻醉或气管插管全麻,先行URSL,将结石击碎成若干较大碎石块,结石或碎石块上移达接近肾盂水平后,在B超引导下穿刺肾盂或目标肾盏成功后,依次扩张通道至16 F或24 F,用EMS第四代碎石清石系统碎石。结果:36例均穿刺成功并能良好耐受手术,患者无因体位不适终止手术者。平均手术时间(75±25)min。一次性结石清除率为91.6%(33/36),残留结石3例,其中行二期手术取尽结石1例。术后高热2例。无胸膜、腹腔脏器损伤等并发症发生。结论:斜仰截石位URSL联合PCNL治疗复杂性输尿管上段结石安全有效,患者耐受性好。
Objective: To study the safety and efficacy of oblique lithotomy ureteroscopy combined with percutaneous nephrolithotomy in the treatment of complex upper ureteral calculi. Methods: From February 2011 to February 2012, 36 patients with complicated ureteral calculi were treated by oblique lithotomy combined with percutaneous nephrolithotomy. The mean age was (47 ± 15) years. The stones were located on the left side in 20 cases. Right in 16 cases. The largest diameter of stones 1.5-3.0 cm, with an average (2.0 ± 1.0) cm. After placing the position of the patient as a whole into a oblique lithotomy position. Continuous epidural anesthesia or endotracheal intubation general anesthesia, URSL first, the stones crushed into a number of larger gravel, stones or gravel on the transfer up to the renal pelvis level, the B-guided puncture renal pelvis or target After the calyx success, followed by expansion of the channel to 16 F or 24 F, with EMS fourth gravel lithotripsy system gravel. Results: Thirty-six cases were successfully punctured and well tolerated. Patients were not terminated because of discomfort. The average operation time (75 ± 25) min. One-time stone clearance rate was 91.6% (33/36), residual stones in 3 cases, of which 2 cases of surgery to remove stones in 1 case. Postoperative fever in 2 cases. No pleura, abdominal organ injury and other complications. CONCLUSION: URSL combined with PCNL is safe and effective in the treatment of complex upper ureteral calculi. The patients are well tolerated.