目的：探讨同期微创手术治疗双侧上尿路结石(bilateral upper urinary calculi,BUUC)的安全性及有效性。方法回顾分析54例BUUC患者的临床资料：男31例,女23例,年龄21~67岁,平均43岁；双肾结石15例；一侧肾结石、对侧输尿管结石21例；双侧输尿管结石18例；结石直径约0.6~3.5cm,平均1.6cm；数量2~5枚,平均3.7枚。均同期行经皮肾镜碎石取石术或(和)经尿道输尿管镜钬激光碎石术。结果手术均顺利,手术时间25~115min,平均67min；术中失血量20~650ml,平均220ml；输血3例,输血量200~500 ml,平均300ml；一次性结石清除率85.2%,8例(14.8%)肾脏残石行二期微创手术治疗；1例(1.9%)继发感染性休克；术后平均4d内拔除肾造瘘管及尿管,术后平均6.5d出院。随访2~38个月,平均18.4个月,无结石复发、肾积水及输尿管狭窄。结论：对于体积小、数量少的BUUC行同期微创碎石术,安全有效,降低了住院时间及费用,但需考虑患者手术耐受性,严格控制碎石时间,以减少并发症。%Objective To introduce our experiences and assess clinic safety, outcome and ef icacy of simultaneous bilateral percutaneous nephrolithotomy (PCNL) or (and) ureterorenoscope lithotomy (URSL) performed for bilateral upper urinary calculi (BUUC) in selected cases. Methods A retrospective study was done in 54 patients (31 men and 23 women) underwent simultaneous bilateral PCNL or (and) URSL for BUUC (bilateral renal calculi in 15 cases, bilateral ureter calculi in 18, renal and contralateral ureter calculi in 21). The average diameter and amount of stones were 1.6 cm (0.6 cm to 3.5 cm) and 3.7 (2 to 5), respectively. In al cases,double J stents and nephrostomy tubes were placed during PCNL procedures. Results Al operations were performed successful y. The average procedure time and blood loss were 67 min (25 min to 115 min) and 220ml (20 ml to 650 ml), respectively. Transfusions of 200 ml to 500 ml RBC were taken in 3 cases. The rate of complete stone clearance was 85.2%. Residual renal stone fragments in 8 cases (14.8%) were treated by second PCNL. One patient (1.9%) caught a secondary septic shock after PCNL. Al were dislodged nephrostomy tubes and discharged uneventful y after 4 and 6.5 days stay, respectively. During 2 to 38 months' fol ow-up (mean 18.4 months), no hydronepherosis, calculus or ureteral obstruction was shown in al patients by ultrasonography or KUB+IVP. Conclusion Simultaneous bilateral PCNL or (and) URSL is technical y feasible and viable option to select patients with smal and less BUUC. It decreases cost and time of hospitalization. Time of procedures needs shorten maximally to reduce complication.
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