输尿管中下段结石并感染的内镜治疗

Endoscopic treatment of middle and lower ureteral stone with infection

目的:探讨输尿管中下段结石并感染的内镜治疗方法。方法:回顾性分析33例输尿管中下段结石并感染患者的临床资料,采用一期导管旁输尿管镜气压弹道碎石术治疗21例;先期行经皮肾造瘘,二期行输尿管镜碎石取石术12例。结果:施行一期输尿管镜碎石术的21例患者中,2例术中改为经皮肾穿刺造瘘,2例术后出现不同程度的发热和肾区胀痛。施行经皮肾造瘘后二期输尿管镜碎石取石术的12例患者中,无一例术后出现发热及肾区胀痛。结论:对于输尿管中下段结石并感染患者,如血常规正常、肾积水较轻且B超透声好、体温正常,可行导管旁输尿管镜气压弹道碎石术;而对于血常规指标高、肾积水重且B超透声差、伴发热者,应先期行经皮肾造瘘,二期行输尿管镜碎石取石术。

Objective：To explore endoscopic treatment of middle and lower ureteral stone with infection. Methods：Twenty-one cases were treated with pneumatic lithortriptsy under ureteroscope beside the ureteral catheter; twelve cases were treated with puncture percutaneous nephrostomy first, and then treated with pneumatic lithortriptsy under ureteroscope. Results： In the twenty one cases with one-stage pneumatic lithortriptsy under ureteroscope, two cases were changed to percutaneous nephrostomy during operation, two cases suffered from fever and renal pain after operation. No fever and renal pain occurred in the twelve cases treated with pneu matic lithortriptsy under ureteroscope after puncture percutaneous nephrostomy operatively. Conclusions： For the patient of middle and lower ureteral stone with infection, the method of one stage pneumatic lithortriptsy under ureteroscope beside the ureteral catheter can treat the patient with normal hemogram, normal temperature, low grade hydronephrosis and nicer ultrasonic sound transparent property, But the patient with high hemogram, fever, high-grade hydronephrosis and worse ultrasonic sound transparent property should be treated with two-stage pneu-matic lithortriptsy under ureteroscope after puncture percutaneous nephrostomy.