输尿管镜碎石取石术失败原因的临床分析

Clinical analysis of the reasons of failure ureteroscopy operation for ureteral calculus

目的对输尿管镜治疗输尿管结石的失败原因进行分析,探讨预防和处理方法。方法回顾分析150例输尿管镜碎石取石术治疗输尿管结石的资料,对取石失败的原因进行分析。结果150例共进行167次单侧输尿管镜手术,其中145次手术取尽单侧结石,成功率86.8%;取石失败有22例,其中4例为找不到输尿管开口,5例为输尿管狭窄入镜困难,6例为结石上移至肾盂肾盏,3例为息肉包裹结石,2例为假道形成,2例为输尿管穿孔。结论入镜困难和术中结石上移是输尿管镜碎石取石术失败的主要原因。术中小心进镜,熟练处理各种可能影响术野的因素,可提高手术成功率。

Objective To analyze the reasons of failure ureteroscopy operation for ureteral calculus and explore the way to prevent and handle failure ureteroscopy operation. Methods Reviewed the clinical data of 150 patients with ureteroscopy operation for ureteral calculus,Failure operation in these cases were analysed respectively. Results Total 167 ureteroscopy operations were performed in 150 cases. 145 operations were successful in removeing the lateral ureterolith （86.8%）. 22 cases were failure, including the difficult of searching the ureteral orifice（4 cases）, the difficult of ureteroscopy insert （5 cases）, the upward pushing of the stone（6 cases）, difficult of calculi disposal because of polypus shaped （3 cases）, false passage shaped （2 cases）and ureteral perforation （2 cases）. Conclusion The main reasons of failure ureteroscopy operatin are difficulty of ureteroscopy insert and the upward pushing of the stone. Carefully ureteroscopy inserting and skillful technique in dealing with any factors which can influence the field of vision are benefit to elevate the successful rate in ureteroscopy operation for revoming ureterolith.