【摘要】 目的报告经尿道和经皮肾途径输尿管镜下钬激光治疗输尿管嵌顿性结石并输尿管息肉的经验与疗效。方法2000年8月～2006年9月应用输尿管镜钬激光碎石息肉消融术经尿道和经皮肾途径治疗69例嵌顿性输尿管结石并息肉,术后4～6周拔除输尿管内支架管,术后3～6个月泌尿系B超和/或静脉肾盂造影对术后情况进行复查和随访。结果47例行经尿道输尿管镜钬激光碎石息肉消融术治疗,其中38例一期手术获得成功,术中因输尿管穿孔改开放手术2例,4例输尿管上段结石因输尿管扭曲输尿管镜无法到达输尿管梗阻部位,改经皮肾途径手术成功,3例术后尿路造影提示病变处输尿管碎石颗粒聚积,二期经尿道输尿管镜钬激光治疗后治愈;经皮肾输尿管镜钬激光碎石息肉消融术治疗22例,均一期手术获得成功。术后随访患肾积水均有改善,患侧输尿管引流正常,未发生输尿管狭窄和息肉复发。结论经尿道和经皮肾输尿管镜下钬激光碎石息肉消融术治疗嵌顿性输尿管结石并息肉是一种可靠而有效的方法;处理合并输尿管上段包裹性息肉时,经皮肾途径无论是在操作安全性和结石取净率上较经尿道途径更为优越。更多还原

【Abstract】 【Objectives】To report the outcomes and our experience on the endoscopic treatment of compacted ureteral calculi complicated with polyps of ureter. 【Methods】From August 2000 to September 2006, 69 patients underwent either percutaneous or transurethral treatment of impacted ureteral calculi complicated with polyps of ureter by ureteroscopic holmium:yttrium-aluminum-garnet laser lithotripsy and resection. Ureteral stents were left indwelling for 4～6 weeks postoperatively. All the patients had a follow-up for 3～6 months using IVU or ultrasonography. 【Results】 47 cases underwent ureteroscopic holmium:YAG laser lithotripsy and resection with transurethral approach. Of them, single-procedure in 41 cases were succeeded, 2 cases were changed to open operation because of intraoperative ureteral perforation, 4 upper ureteral stones were altered to percutaneous approach for the inaccessible to ureteroscopy by transurethral approach, and 3 cases were experienced the second operation because of the incomplete removal of the polyps during the first procedure; 22 cases underwent a single session with percutaneous approach, all of them were proved to be successful. On follow-up examination at 3～6 months from surgery, the same residual hydronephrotic dilatation was found minimized and was draining normally. To date, no patients have developed a ureteral stricture or experienced a polyps recurrence. 【Conclusions】 Ureteroscopic holmium: YAG laser lithotripsy and resection with percutaneous or transurethral approach is an acceptable management to treat compacted ureteral calculi complicated with fibroepithelial polyps of ureter. Our study demonstrates that the percutaneous approach is more effective than the transurethral approach to the upper ureteral lesion.更多还原