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目的:探讨第4、5腰椎水平难治性输尿管结石的处理方法。方法:采用经皮肾穿刺造瘘联合经尿道输尿管镜气压弹道/钬激光碎石术治疗第4、5腰椎水平难治性输尿管结石患者20例。结果:20例均在B超引导下成功穿刺建立经皮肾通道,留置肾造瘘管(气囊型)于肾盂输尿管连接部下方,一期行经尿道输尿管镜碎石术,手术时间平均48 min(30～70 min),清石率为100%,未出现严重并发症。结论:经皮肾穿刺造瘘联合经尿道输尿管镜碎石术治疗第4、5腰椎水平难治性输尿管结石安全、有效。
Objective: To investigate the treatment of refractory ureteral calculi in the fourth and fifth lumbar spine. Methods: Percutaneous nephrostomy combined with transurethral ureteroscopic pneumatic ballistics / holmium laser lithotripsy was used to treat 20 patients with refractory ureteral calculi in the fourth and fourth lumbar spine. Results: Twenty patients underwent percutaneous transurethral renal biopsy under the guidance of B-mode ultrasound. The renal fistula (balloon type) was placed below the ureteropelvic junction, and ureteroscopic lithotripsy was performed in one stage. The mean operative time was 48 min (30 ~ 70 min), clear stone rate was 100%, no serious complications. Conclusion: Percutaneous nephrostomy combined with transurethral ureteroscopic lithotripsy is safe and effective in the treatment of refractory ureteral calculi in the fourth and fourth lumbar spine.