输尿管镜气压弹道碎石术治疗尿路结石(附2368例报告)

Ureteroscopic Lithotripsy in Treatment of Urethral Calculus (Report of 2 368 Cases)

目的探讨输尿管镜气压弹道碎石术治疗尿路结石的临床疗效。方法回顾性分析2368例输尿管结石及下尿路结石患者采用输尿管镜气压弹道碎石术治疗的临床资料。结果2368例一次性碎石成功率为98.2%,其中下段输尿管结石为98.0%(985/1005)、中段为95.0%(798/840)、上段为81.8%(203/248)。输尿管穿孔32例,输尿管狭窄3例,尿路感染372例。无输尿管断裂,粘膜脱套伤等严重并发症。结论输尿管镜气压弹道碎石术具有微创、安全、疗效确切、术后恢复快等优点,可作为输尿管中下段结石的首选方法;Peel-away鞘应用于下尿路结石输尿管镜气压弹道碎石有利于提高碎石效果及保护尿道粘膜。

Objective：To investigate the clinic effects of ureteroscopic lithotripsy in treatment of urethral calculi. Methods. The clinical data of 2 368 cases diagnosed as urethral calculi and lower urinary tract calculi treated with ureteroscopic lithotripsy were analyzed retrospectively. Results： Stones were fragmented successfully on one session in 98.2%. In these cases, the stone clearance rate was 81.8% （203/248 cases） in upper ureter, 95.0% （798/840 cases） in middle ureter and 98.0% （985/1 005 cases） in inferior ureter. Complications were observed in 32 cases of urethral perforation, 3 of urethral stenosis and 372 cases with urinary tract infection postoperative. No urethral rupture or mucosal avulsion and other serious complications occured. Conclusion： Ureteroscopic lithotripsy had the advantages of minimal invasion, safety, fast convalescence and positive therapeutic effects which could be the first option for the middle and inferior urethral calculus. It would improve the stone clearance rate and protect the urethral mucosal if the Peel--away sheath were used in the treatment of lower urinary tract calculus.