输尿管镜下气压弹道碎石术治疗输尿管结石

Treatment of ureteral calculus with transurethral ureteroscopic pneumatic lithotripsy

目的探讨输尿管0镜下气压弹道碎石治疗输尿管结石的疗效。方法2002年9月-2005年8月对320例输尿管结石采用德国Wolf F9.8输尿管硬镜和瑞士EMS气压弹道碎石机经尿道置镜碎石,碎石针直径0.8 mm或1.0 mm,碎石压力200-300 kPa,采用单次或连续击发的方式碎石。结果6例结石冲回肾盂,改体外冲击波碎石治疗;5例插输尿管镜、碎石失败,改开放手术。碎石时间2-10 min,平均5.5 min。术中出血量3-15 ml,平均7 ml。309例碎石成功,成功率96.6%(309/320)。术后住院时间3-7 d,平均4.5 d。24例输尿管黏膜损伤,4例形成假道,置双J管1个月后痊愈。309例随访1-10个月,平均4个月,1个月内结石全部排净,未出现输尿管狭窄、尿路感染等并发症。结论输尿管镜下气压弹道碎石治疗输尿管结石方法安全、疗效可靠。

Objective To investigate therapeutic effects of transurethral ureteroscopic pneumatic lithotripsy(TUPL).Methods A retrospective analysis was made on 320 cases of ureteral calculus treated with TUPL from September 2002 to August 2005.A Wolf F9.8 rigid ureteroscope and an EMS pneumatic ballistic lithotriptor were used.The probe was 0.8 mm or 1.0 mm in diameter.The pulse settings was 200~300 kPa.The fragmentation was conducted with single or multiple episode of treatment.Results The stone was pushed back to the renal pelvis in 6 cases and a conversion to extracorporeal shock wave lithotripsy(ESWL) was needed.The insertion of the ureteroscope was failed in 5 cases and a conversion to open surgery was required.The TUPL time was 2~10 min(mean,5.5 min) and the intraoperative blood loss was 3~15 ml(mean,7 ml).The stones were successfully fragmented on one session in 309 cases,the success rate being 96.6%(309/320).The length of postoperative hospital stay was 3~7 d(mean,4.5 d).There were 24 cases of mucosal injury of the ureter and 4 cases of false passage,all of which were cured with double-J catheter indwelling for 1 month.Follow-up examinations for 1~10 months(mean,4 months) showed stone clearance within 1 month and no ureteral stenosis or urinary infection.Conclusions Transurethral ureteroscopic pneumatic lithotripsy for the treatment of ureteral calculus is safe and effective.