Robert M, Drianno N, Marotta J, Delbos O, Guiter J, Grasset D
Service d'Urologie I, Hôpital Lapeyronie, Montpellier, France.
Prog Urol. 1997 Feb;7(1):35-41.
To assess the value of retrograde endoscopic lithotripsy for very large pyelocaliceal stones.
Eighteen patients between the ages of 28 and 80 years (mean : 52) and presenting a staghorn renal calculus (n = 7) or with a maximal diameter greater than or equal to 20 mm (n = 11) were initially managed by rigid or flexible retrograde ureterorenoscopy, with ballistic (Lithoclast) or electrohydraulic (Riwolith) stone fragmentation. In 16 cases (89%), an additional extracorporeal shock-wave lithotripsy (ESWL) session was performed immediately after the endoscopic procedure. Early complications consisted of 3 cases of bacteraemic discharge rapîdly responding to medical treatment and 1 death from septic shock on the 8th postoperative day. Twelve patients (67%) were subsequently treated by ureteroscopy (n = 4) or ESWL (n = 11).
17 patients were evaluated after this therapeutic procedure, with a follow-up of 3 to 6 months (mean : 4). Stone elimination was complete for 8 patients (47%), 3 of whom initially presented a staghorn calculus. A residual stone was observed in 9 cases (53%), with a maximal diameter < 5 mm in 7 cases (41%). One patient (5%) underwent secondary percutaneous nephrolithotomy.
Technological progress has clearly facilitated the ureteroscopic approach to very large pyelocaliceal stones, but fragmentation and stone elimination remain problematical. This unconventional approach constitutes a potential field of technical progress, but does not represent a really efficient alternative to PCNL at the present time.
评估逆行内镜碎石术治疗巨大肾盂肾盏结石的价值。
18例年龄在28至80岁之间（平均52岁）的患者，患有鹿角形肾结石（7例）或最大直径大于或等于20mm的结石（11例），最初采用硬性或软性逆行输尿管肾镜检查，并使用弹道式（碎石钳）或液电式（瑞沃碎石机）进行结石破碎。16例（89%）患者在内镜手术后立即进行了一次体外冲击波碎石术（ESWL）。早期并发症包括3例菌血症性引流，经药物治疗后迅速缓解，以及1例术后第8天死于感染性休克。12例患者（67%）随后接受了输尿管镜检查（4例）或ESWL（11例）治疗。
17例患者在该治疗过程后接受评估，随访3至6个月（平均4个月）。8例患者（47%）结石完全清除，其中3例最初为鹿角形结石。9例（53%）患者有残余结石，7例（41%）最大直径<5mm。1例患者（5%）接受了二期经皮肾镜取石术。
技术进步明显促进了输尿管镜治疗巨大肾盂肾盏结石，但结石破碎和清除仍存在问题。这种非常规方法构成了一个潜在的技术进步领域，但目前还不是经皮肾镜取石术真正有效的替代方法。
