Segura J W, LeRoy A J
Ann Acad Med Singap. 1984 Oct;13(4):610-5.
Endoscopic surgery of the upper urinary tract had made rapid advances in the past three years. At our institution endoscopic removal of upper urinary tract stones had almost replaced open surgical procedure which is now done in only about 2% of the surgical stones seen. Over 1,000 cases of percutaneous stone removal had been done and for renal and uretero-pelvic junction stones our success rate is 96% while ureteral stones are less amenable to removal and the success rate is about 86%. Complications include procedure bleeding, entravasation of irrigating fluids, perforation of the collecting system and sepsis. All these are rare and can be managed conservatively. A more serious complication is that of AV malformation in six cases out of 1,000 patients due to damage to renal vessels. Fortunately this can be treated with arteriography and embolisation. Retained fragment rate is about 6%, these are, however, non-surgical fragments. Percutaneous techniques may also be used for diagnostic inspection of the collecting system and for treatment of certain cases of uretero-pelvic junction obstruction. Instruments are now also available for transurethral uretero-renoscopy, it is generally possible to manipulate and remove many ureteral stones under direct vision.
上尿路内镜手术在过去三年中取得了迅速进展。在我们机构，上尿路结石的内镜取出术几乎已取代开放手术，目前开放手术仅用于约2%的所见手术结石病例。已完成1000多例经皮取石术，对于肾和输尿管肾盂连接部结石，我们的成功率为96%，而输尿管结石较难取出，成功率约为86%。并发症包括手术出血、冲洗液外渗、集合系统穿孔和败血症。所有这些都很罕见，可保守处理。一种更严重的并发症是，在1000例患者中有6例因肾血管损伤出现动静脉畸形。幸运的是，这可通过动脉造影和栓塞治疗。残留碎片率约为6%，不过这些是无需手术处理的碎片。经皮技术也可用于集合系统的诊断检查以及某些输尿管肾盂连接部梗阻病例的治疗。现在也有用于经尿道输尿管肾镜检查的器械，一般能够在直视下操作并取出许多输尿管结石。
