输尿管镜下气压弹道碎石术治疗输尿管结石378例

Pneumatic Ureteroscopic Lithotripsy for Ureteral Calculi:Report of 378 Cases

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的临床效果。方法采用W olf F8/9.8硬性输尿管镜,瑞士产第二代EMS气压弹道碎石机,治疗378例输尿管结石。左侧213例,右侧158例,双侧7例。输尿管上段81侧,中段146侧,下段158侧。结果313例(320侧)单次碎石成功,输尿管上、中、下段结石碎石成功率分别为60.5%(49/81)、84.2%(123/146)、93.7%(148/158),1～8周内结石全部排净,结石排净率82.8%(313/378)。15例改开放手术。置镜失败3例。主要并发症有输尿管穿孔8例、发热13例。结论输尿管镜气压弹道碎石治疗输尿管结石安全、微创、效果确切,是治疗输尿管中、下段结石的首选方法。

Objective To evaluate the effect of pneumatic ureteroscopic lithotripsy （URSL） for ureteral calculi. Methods A total of 378 cases of uretera] calculi received URSL in our hospital by using F8/9.8 Wolf rigid ureteroseope and EMS Ⅱ pneumatic lithotripter （Switzerland）. Among the cases, 213 had calculi at the left side, 158 at the right side, and 7 at the both sides; 81 had the stones in the upper ureter, 146 in the middle segment, and 158 in the lower part. Results In the cases, 313 patients （320 sides） were cured after the first operation with a success rate of 82.8% （313/378）. The success rates for the upper, middle, and lower ureteral calculi were 60. 5% （49/81）, 84. 2% （ 123/146）, and 93.7% （ 148/158 ）, respectively. The stones were removed completed in 1 to 8 weeks after the procedure. Fifteen patients were converted to an open surgery. In 3 patients, the URSL were stopped due to failure in placing the ureteroscope. The main postoperative complications in our series included perforation of the ureter （8 cases） and fever （13）. Conclusions USRL is a safe, minimally invasive, and effective treatment. It should be the first choice for middle and lower ureteral calculi.