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[摘要] 目的：观察微创经皮输尿管镜取石术治疗上尿系结石的疗效，探讨输尿管上段结石的治疗方法。方法：观察组行微创经皮输尿管镜取石术，对照组行传统输尿管切开取石术。结果：两组结石清除率均为100%（P＞0.05）。经治疗后，观察组在手术时间、术后住院时间、术中出血量方面均小于对照组，差异有统计学意义（P＜0.05）。结论：微创经皮输尿管镜取石术治疗输尿管上段结石清除率高，手术时间及术后住院时间短、术中出血量少，值得临床推广。
[关键词] 微创经皮输尿管镜取石术；输尿管上段结石；输尿管切开取石术
[中图分类号] R691.4 [文献标识码]A[文章编号]1674-4721（2011）02（c）-027-02
Minimally invasive percutaneous ureteroscopic stone surgery on the efficacy of upper ureteral calculi observation and analysis
LIU Qiang1, ZHANG Xiaozhong2, HUANG Ying2, WU Shaowen2
(1.Department of Urology, Longhua Branch of Shenzhen People′s Hospital, Guangdong Province, Shenzhen 518109, China; 2.Department of Urology, Zhongshan Hospital of Shenzhen City, Guangdong Province, Shenzhen 518001, China)
[Abstract] Objective: Minimally invasive percutaneous ureteroscopic stone treatment on urinary stone efficacy of ureteral calculi treatment. Methods: Minimally invasive percutaneous group underwent ureteroscopic stone surgery in the control group underwent conventional surgery ureterolithotomy. Results: There were stone clearance rates were 100% (P>0.05). After treatment, the observation group operation time, hospitalization time, blood loss, less than the control group terms, the difference was statistically significant (P 微创经皮输尿管镜取石术，需在X线或超声指导下穿刺肾盂，然后将穿刺通道扩张至需要大小，经此通道放入输尿管镜，窥视下将结石击碎后取出。选择合适的穿刺点和成功穿刺以建立工作通道，是手术成功的关键[5-6]。在通道扩张过程中，注意将导丝拉直，筋膜扩张器在推进过程中防止过深，防止穿破肾盂，完成后要固定导丝，以防脱出，避免重新穿刺。
微创经皮输尿管镜取石术的适应证有肾及输尿管上段结石，开放手术难以处理的鹿角状肾结石、开放手术后残留结石、肾与输尿管连接部狭窄或闭锁、肾积水、上尿路手术后尿漏等。凝血机制障碍、对造影剂过敏、过于肥胖穿刺针不能达到肾、或脊柱畸形者为经皮输尿管镜取石术的禁忌证[7]。行微创经皮输尿管镜取石术常见手术并发症有术中、后出血，术中出血可影响取石率。本组病例在手术完成后，继续夹闭引流管30～60 min，避免了术后出血的发生。邻近脏器的损伤不常见，但一旦发生，后果严重。因此，术中穿刺定位要准确，入针和扩张宁浅勿深。
总之，微创经皮输尿管镜取石术，结石清除率高，手术时间短，术中出血量少，并发症少，患者痛苦少，值得临床推广。
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（收稿日期：2010-12-07）
