输尿管镜气压弹道碎石术治疗输尿管结石

Management of ureteral calculi with ureteroscopic pneumatic lithotripsy

目的探讨输尿管镜气压弹道碎石术治疗输尿管结石的操作方法和疗效。方法回顾性分析308例应用硬性输尿管镜和气压弹道碎石术治疗输尿管结石资料。其中男192例,女116例;平均年龄42岁。上段结石33例,5例行经尿道输尿管镜气压弹道碎石术,28例并大量肾积水患者行微创经皮肾输尿管镜气压弹道碎石术;中段结石91例,下段184例,均行经尿道输尿管镜气压弹道碎石术。结果一次性结石碎石成功率为98.4%,其中1例输尿管上段结石,4例中段结石因结石上移至肾盂放置双J管,术后行ESW L碎石成功。1例下段结石因输尿管断裂而改行开放手术吻合输尿管,术后随诊无并发输尿管坏死、狭窄。303例术后平均住院2.8天,术后随访2周—3个月,肾盂积水由术前(3.4±0.8)cm降至(1.4±0.4)(p<0.01)cm,无输尿管狭窄发生。结论输尿管镜气压弹道碎石术治疗各段输尿管结石效果好,损伤小,并发症少。

Objective To evaluate the treatment and the curative effect of ureteral calculi with pneumatic lithotripter. Methods We retrospectively reviewed the data of 308 patients （192 males and 116 females,with an average age of 42 years）who were treated with the above -mentioned lithotripsy, Among these patients,33 had stones in the upper （5 cases were treated per urethra,28 cases with a great quantity hydronephrosis were treated through minimal invasive percutaneous nephrostomy）, 91 in the middle, 184. in the lower ureter.（thery were treated per urethra）, Results The overall rates of successful fragmentation for all levels of ureterat stones in a single procedure achieved 98.4% .5 cases were placed pigtail duct because of stone migration, the stone were fragmented by ESWL post operation, One cases converted to open due to repair the broken ureteral,The mean postoperative hospital stay was 2.8 days, In 303 patients,the postoperative follow-up of 2 weeks to 3 months revealed that the hydronephrosis was markedly improved from preoperative （3.4±0.8）cm to postoperative （1.4±0.4） cm according to B-ultrasound and IVU,No ureteral stenosis occurred, Conclusions Treatment of all levels of urinaric calculies with ureteroscopic pneumatic lithotripsy has been more successful, effective an less invasive.