重复肾输尿管畸形合并上尿路结石内镜手术的策略

doi:10.19723/j.issn.1671-167X.2026.04.011

摘要/Abstract

摘要：

目的: 探讨重复肾输尿管畸形合并上尿路结石的内镜手术治疗策略，总结不同畸形亚型的个体化诊疗经验，为该疾病的临床规范化处置提供参考。方法: 回顾性分析2012年11月至2025年12月于北京大学第三医院泌尿外科接受内镜手术治疗的重复肾输尿管畸形合并上尿路结石患者的临床资料，收集患者基线特征、影像学检查结果、围术期指标、并发症及肾功能变化等数据，总结不同畸形亚型的内镜手术技巧与核心诊疗要点，采用SPSS 22.0及R 3.6.1软件进行统计学分析。结果: 共纳入38例患者，其中男性16例，女性22例，平均年龄(49.92±14.27)岁，中位随访时间17.80(1.60~41.90)个月。临床症状以腰痛为主(32例，84.21%)，畸形分型以单侧不完全性重复肾输尿管畸形占比最高(24例，63.16%)。根据畸形分型与结石特征，所有患者均依据术前计算机断层扫描尿路成像等影像学精准评估，个体化选择手术方案：15例患者行输尿管硬镜碎石取石术(ureteroscopic lithotripsy, URL)，15例行输尿管软镜碎石取石术(flexible ureteroscopic lithotripsy, FURL)，7例行经皮肾镜碎石取石术(percutaneous nephrolithotomy, PCNL)，1例行PCNL联合FURL治疗。患者中位手术时间74.00(64.75~92.50) min，中位术中出血量2.00(1.00~4.25) mL，中位术后住院时间3.00(2.00~5.75) d，术后整体清石率达94.74%。围术期无严重并发症发生，14例(36.84%)患者出现术后发热，经对症治疗后均痊愈。术后患者血肌酐水平较术前显著降低(P＜0.05)，肾功能显著改善。结论: 内镜手术治疗重复肾输尿管畸形合并上尿路结石安全、有效，具有创伤小、恢复快、清石率高的优势；通过“精准诊断-个体化术式选择”的策略，可针对不同畸形亚型制定个性化方案，值得临床推广应用。

关键词: 重复肾输尿管畸形, 上尿路结石, 输尿管镜, 经皮肾镜, 内镜手术

Abstract:

Objective: To investigate the endoscopic surgical management strategies for duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, to summarize individualized diagnostic and therapeutic experiences for different anomaly subtypes, and to provide a reference for standardized clinical management of this condition. Methods: The clinical data of patients with duplex kidney and ureteral duplication anomalies and upper urinary tract calculi who underwent endoscopic surgery at the Department of Urology, Peking University Third Hospital from November 2012 to December 2025 were retrospectively analyzed. Baseline characteristics, imaging findings, perioperative parameters, complications, and changes in renal function were collected. Endoscopic surgical techniques and key diagnostic and therapeutic points for different anomaly subtypes were summarized. Statistical analysis was performed using SPSS 22.0 and R 3.6.1 software. Results: A total of 38 patients were enrolled, including 16 males and 22 females, with a mean age of (49.92±14.27) years. The median follow-up duration was 17.80 months (1.60-41.90). The predominant clinical symptom was flank pain (32 cases, 84.21%). The most common anomaly subtype was unilateral incomplete duplex kidney and ureteral duplication (24 cases, 63.16%). Based on the anomaly subtype and stone characteristics, all the patients underwent precise preoperative assessment using CT urography and other imaging modalities, and indivi-dualized surgical approaches were selected: In the study, 15 patients underwent ureteroscopic lithotripsy (URL), 15 underwent flexible ureteroscopic lithotripsy (FURL), 7 underwent percutaneous nephrolithotomy (PCNL), and 1 patient received PCNL combined with FURL. The median operative time was 74.00 (64.75-92.50) min, the median intraoperative blood loss was 2.00 (1.00-4.25) mL, and the median postoperative hospital stay was 3.00 (2.00-5.75) d. The overall postoperative stone-free rate was 94.74%. No severe perioperative complications occurred. Postoperative fever occurred in 14 patients (36.84%), all of whom recovered after symptomatic treatment. Postoperative serum creatinine levels were significantly lower than preoperative levels (P < 0.05), indicating significant improvement in renal function. Conclusion: Endoscopic surgery is safe and effective for the treatment of duplex kidney and ureteral duplication anomalies complicated by upper urinary tract calculi, offering advantages of minimal trauma, rapid recovery, and a high stone-free rate. The strategy of "precise diagnosis-individualized surgical approach selection" allows the formulation of tailored treatment plans for different anomaly subtypes and is worthy of clinical promotion and application.

Key words: Duplex kidney and ureteral duplication, Upper urinary tract calculi, Ureteroscopy, Percutaneous nephrolithotomy, Endoscopic surgery

中图分类号:

R693.1

杨新纪, 林秀石, 谢志飞, 刘余庆, 肖春雷, 张树栋, 侯小飞, 邱敏. 重复肾输尿管畸形合并上尿路结石内镜手术的策略[J]. 北京大学学报（医学版）, 2026, 58(4): 754-761.

Xinji YANG, Xiushi LIN, Zhifei XIE, Yuqing LIU, Chunlei XIAO, Shudong ZHANG, Xiaofei HOU, Min QIU. Analysis of endoscopic surgical strategies for duplex kidney and ureteral malformation complicated with upper urinary tract calculi[J]. Journal of Peking University (Health Sciences), 2026, 58(4): 754-761.

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参考文献 16

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Variables	Patients (n=38)
Gender, n (%)
Male	16 (42.11)
Female	22 (57.89)
Age/years, $\bar x \pm s$	49.92±14.27
BMI/(kg/m²), M (P₂₅，P₇₅)	25.01 (22.63, 26.47)
Symptoms, n (%)
Low back pain	32 (84.21)
Lower urinary tract irritation symptoms	10 (26.32)
Lower urinary tract obstruction symptoms	3 (7.89)
Hematuria	12 (31.58)
Fever	6 (15.79)
Nausea and vomiting	7 (18.42)
Detected during physical examination	3 (7.89)
Duration of symptoms/d, M (P₂₅，P₇₅)	30.00 (21.50, 165.00)
Basic medical history, n (%)
Hypertension	13 (34.21)
Diabetes mellitus	6 (15.79)
Coronary heart disease	4 (10.53)

Variables	Patients (n=38)
Side of Ureteral duplication, n (%)
Left	12 (31.58)
Right	17 (44.74)
Bilateral	9 (23.68)
Type of Ureteral duplication, n (%)
Unilateral incompletely	24 (63.16)
Unilateral completely	4 (10.53)
Bilateral incompletely	1 (2.63)
Bilateral completely	3 (7.89)
Bilateral completely and contralateral incompletely	5 (13.16)
Unilateral inverted Y	1 (2.63)
Stone location, n (%)
Calices renales of the upper kidney	10 (26.32)
Calices renales of the lower kidney	8 (21.05)
Ureteropelvic junction	6 (15.79)
Ureter	11 (28.95)
Multiple locations	3 (7.89)
Number of stones, n (%)
1	21 (55.26)
2	2 (5.26)
Multiple	15 (39.48)
Maximum stone diameter/cm, M (P₂₅，P₇₅)	1.06 (0.84, 1.48)
Stone CT value/HU, $\bar x \pm s$	897.82±348.62
Pelvic hydronephrosis, n (%)	23 (60.53)
Hydronephrosis size/cm, M (P₂₅，P₇₅)	3.43 (2.96, 3.79)

Variables	Patients (n=38)
ASA grade, n (%)
Ⅰ	21 (55.26)
Ⅱ	17 (44.74)
Anesthesia method, n (%)
General anesthesia	25 (65.79)
Spinal anesthesia	13 (34.21)
Surgical method, n (%)
URL	15 (39.47)
FURL	15 (39.47)
PCNL	7 (18.43)
PCNL+FURL	1 (2.63)
Intraoperative special conditions, n (%)
Ureteral stricture	19 (50.00)
Ureteral orifice cyst	3 (7.89)
Complete impaction	2 (5.30)
Stricture incision	3 (7.90)
Cyst incision	1 (2.63)
Balloon dilation	2 (5.26)
Surgical time/min, M (P₂₅，P₇₅)	74.00 (64.75, 92.50)
Estimated blood loss/mL, M (P₂₅，P₇₅)	2.0 (1.00, 4.25)

Variables	Patients (n=38)
Postoperative fever, n (%)	14 (36.84)
Complete stone clearance, n (%)	36 (94.74)
Staged Surgery, n (%)	1 (2.63)
Follow-up time/months, M (P₂₅，P₇₅)	17.80 (1.60, 41.90)
Postoperative extubation time/d, M (P₂₅，P₇₅)	37.00 (31.25, 42.25)
Postoperative hospital stay/d, M (P₂₅，P₇₅)	3.00 (2.00, 5.75)
Postoperative creatinine decline, n (%)	32 (84.21)

Variable	Preoperative	Postoperative	V	P value
Creatinine/(μmol/L), M (P₂₅，P₇₅)	75.50 (65.50, 89.70)	70.00 (57.00, 80.00)	43	0.007
Glomerular filtration rate/[mL/(min·1.73 m²)], M (P₂₅，P₇₅)	92.77 (82.79, 102.75)	100.00 (93.00, 113.00)	135	0.033