双侧上尿路结石49例分析

本文报道双侧上尿路结石49例,占同期尿路结石的8.33%(49/588)。本组年龄以21～40岁最多见(29例)。总肾功能正常者29例,合并尿毒症者20例。体会对双侧上尿路结石应积极采取手术治疗;对急性梗阻严重肾功能障碍和(或)感染者,应积极解除梗阻或先作引流;而对梗阻造成慢性肾功能障辞者,应先进行非手术治疗,待肾功能好转后再行手术。肾部分切除术在总肾功能尚好的情况下,不失为一种较好的术式。对双侧上尿路结石的手术侧选择问题,根据肾对抗平衡原理,按下列原则处理:1.结石梗阻不严重,肾功能正常者:(1)双侧输尿管石,应先处理梗阻较重,症状较剧的一侧或双侧结石一次摘除。(2)一侧肾石,对侧输尿管石,一般先摘除输尿管石。(3)双侧肾石,应先处理病变较轻,手术比较简单、安全的一侧。2.结石梗阻和(或)感染较重,并发慢性肾功能不全者:原则上应双侧同期手术,并另置造瘘管遣瘘;若一侧感染严重,对侧结石亦难以取出者,则应先作感染侧引流,再作对侧手术,最后完成引流侧的取石手术。

Bilateral Upper Urinary Tract Lithiasis A Clinical Analysis of 49 Cases

This is a reprot on 49 cases of bilateral upper urinary tract lithiasis with normal renal function including 29 cases,and 20 cases associated with uremia.It consists of 8.33% (49/588)of all urinarg stone cases in the same period.The majority were 21-40 years of age(29 cases).Active surgical treatment for upper urinary tract lithiasis is emphasized.In the cases of acute obstruction with serious renal function should be relieved on time or drained first while chronic renal function impairment caused by obstruction should be treated conservatively with non-operative management first.Operation must be done after the improvement of the renal function.The authors believe that partial nephrectomy in a patient with fairly good renal function is a rather better method in the treatment of complicated renal stones.Which side should be operated upon in a case of bilateral upper urinary tract lithiasis?According to the principle of antagonistic balance of the kidneys,the following rules are to be followed:1.When the blockage is not severe and the renal function is normal--(1)The side on which obstruction and symptoms are more severe when bilateral ureteral stones are present;(2)Where there is renal stones on one side and ureteral stones contralaterally,the ureteral stones stonld be removed first;(3)Where there are bilateral kidney stones,the side in which the lesion is less severe and requires a simpler and safer technique should be disposed first.2.When the obstruction and/or infection is more severe and associated with renal function impairement,principlely,both sides should be operated on one sitting by creating anureterostomy,pyelostomy or nephrostomy for drainage.If the infection is severe on one side white on the opposite side the stone extraction may be difficult,then the infected side should first be drained,the contralateral stone should be extracted subsequently,and finally stone removal of the drained side should be done.