输尿管镜钬激光碎石术中并发输尿管穿孔原因及对策

Cause and Treatment of Ureteral Perforation Complicated with Ureteroscopic Ho: YAG Laser Lithotripsy

目的探讨输尿管镜钬激光治疗输尿管结石并发输尿管穿孔的原因及防治方法。方法回顾性分析2004年8月至2006年12月经尿道输尿管镜钬激光碎石术268例中25例并发输尿管穿孔的临床资料。男14例,女11例;结石单发者21例,多发者4例;上段结石18例,下段结石7例;结石直径1.2～3.2 cm,平均(1.8±0.5)cm,25例均合并输尿管息肉及中、重度肾盂积水。术后常规放置双J管4～8周。结果25例输尿管镜手术时间15～70 min,平均(40.4±8.3)min。11例一次性碎石成功,6例术中改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石治疗。结论输尿管结石合并息肉是输尿管镜钬激光碎石致输尿管穿孔的主要原因之一,术中轻巧操作是预防出现输尿管穿孔的关键,早期及时开放手术可以避免严重并发症的发生。

Objective To evaluate the cause of ureteral perforation complicated with ureteroscopic Ho： YAG laser lithotripsy and improve the prevention and treatment level of this complication. Methods Retrospective analysis of clinical data of 25 patients with ureteral perforation in 268 patients with ureteroscope calculi via transurethral lithotripsy using Ho： YAG laser lithotriptor. There were 14 males and 11 females. 21 of them had 1 stone, and 4 had more than one. 18 cases had stones in the upper ureter and 7 had stones in the lower ureter. The size of stones were 1.2-3.2 cm in diameter with a mean of （ 1.8 ± 0.5 ） cm. All cases were combinded with ployp and nephrohydrosis. Double -J stent was placed after operation. Results The operation time was （15 -70） min with a mean of （40.4 ± 18.3 ） min. 11 cases had one time successful lithotripsy, and 6 cases change to ureterolithotomy in operation. 8 cases received ESWL treatment one week later because of stones shift. Conclusions The ureteral ployp combinded with stones was the main cause of ureteral perforation complicated with ureteroscopic Ho： YAG laser lithotripsy. Light and soft procedure was the key to prevent and treat the perforation. Transfer into open operation in time that could avoid the ocuurrenee of more severe complications.