输尿管镜气压弹道碎石治疗输尿管结石(附200例报告)

TRANSURETEROSCOPIC PNEUMATIC LITHOTRIPSY IN THE TREATMENT OF URETERAL CALCULI (REPORT OF 200 CASES)

目的总结输尿管镜气压弹道碎石术（URSL）治疗输尿管结石的疗效。方法回顾性分析200例采用输尿管镜气压弹道碎石治疗输尿管结石患者的资料。结果碎石成功率为96％（192／200），其中一次性碎石成功率为90．5％（181／200），4～7W内结石全部排尽。8例失败者中5例合并输尿管狭窄，其中2例因操作困难，视野不清直接改开放手术，3例碎石成功，因术后放置双J管失败改开放手术；结石移位造成手术失败3例，其中1例改开放手术，2例结石移位入肾孟，留置双J管后行ESWL治疗；74例（37％）术后有肉眼或镜下血尿，多于1～2d内消失，200例均无穿孔、感染等并发症。结论输尿管镜气压弹道碎石术（URSL）治疗输尿管结石疗效确切、安全、组织损伤小、清除彻底、并发症少，可作为输尿管中段和下段结石的首选治疗方法。

Objective To evaluate transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi. Method Data of 200 cases of ureteral calculi treated with ureteroscopic pneumatic lithotfipsy were reviewed respectively. Results The stone fragmentation rate was 96% （192/200）, 90. 5% （181/200）of which being fragmented on the first treatment session. The main complications were fail to expelled in 4 - 7 weeks. Five cases of the failure group had ureteral stricture ;3 of them underwent shift to open operation, the other 2 experienced failure because of difficulty of placing D - J tube. Three cases also experienced failure because of stone shift in the operation; of them 1 underwent shift to open operation,the other 2 were treated by ESWL. Seventy - four cases （37%）had postoperative hematuria,which disappeared within 1 - 2 d. None of 200 cases had complications of perforation and infection. Conclusion Pneumatic lithotripsy through rigid transurethral ureteroscope is a safe and effective technique with less injury,less complications and complete clearance of the calculi. It can be the first choice in the treatment of calculi in the middle and distal ureter.