输尿管镜下气压弹道碎石治疗输尿管结石失败原因探讨(附36例报告)

EVALUATION OF THE FAILURE OF PNEUMATIC LITHOTRIPSY UNDER URETEROSCOPE URSL FOR URETERAL CALCULI(REPORT OF 36 CASES)

目的:探讨输尿管镜下气压弹道碎石(URSL)治疗输尿管结石失败原因及防治措施。方法:回顾分析36例气压弹道碎石治疗输尿管结石手术失败的临床资料。结果:17例手术中结石移位进入肾盂,无法碎石;8例因输尿管走行迂曲或输尿管狭窄置镜未成功;5例因局部出血或引流不畅导致视野不清终止手术;6例因输尿管穿孔而改开放手术。结论:结石移位、输尿管走行迂曲或狭窄、术中视野不清、输尿管穿孔是手术失败的主要原因。合理选择病例,保持液适当的灌注速度和压力,保持视野的清晰和在直视下推进输尿管镜是手术成功的关键。

Objective： To explore the causes and prophylaxer of the failure of URSL for ureteral calculi. Methods： The data of 36 cases of failure in URSL for ureteral calculi were retrospectively analyzed.Results：17 cases were abandoned because of stone migration to renal pelvis,8 cases were stopped owing to the tortuosity or the narrowness of ureters,5 cases failed because operation area was not clear,6 cases were managed by open ureterolithotomy because of ureteral perforation. Conclusion： The main causes of the failure of URSL for ureteral calculi are stone migrations, tortuous or narrow ureters, unclear operation area and ureteral perforation.The selection of suitable cases , appropriate flow rate and pressure of the perfusion fluid, keeping operation area clear, and performing ureteroscopy under the vision are keys to successful operation.