输尿管镜下气压弹道碎石术治疗输尿管结石

Treatment of ureteral calculus with transurethral ureteroscopic pneumatic lithotripsy

目的探讨输尿管镜下气压弹道碎石治疗输尿管结石的疗效。方法2004年9月至2008年3月对89例输尿管结石采用德国WolfF8/9.8输尿管硬镜和瑞士EMS气压弹道碎石机经尿道置镜碎石,碎石针直径1.0mm,碎石压力300kPa,采用单次或连续击发的方式碎石。结果3例结石冲回肾盂,改体外冲击波碎石治疗;5例插输尿管镜、碎石失败,改开放手术。碎石时间2～25min,平均15min。术中出血量3～15ml平均7ml。其余81例碎石成功,成功率92.3%(81/89)。术后住院时间3～7d,平均4.5d。8例输尿管黏膜损伤,2例形成假道,置双J管1个月后痊愈。81例随访1～10个月,平均4个月,1个月内结石全部排净,未出现输尿管狭窄、尿路感染等并发症。结论输尿管镜下气压弹道碎石治疗输尿管结石方法安全,疗效可靠。

Objective To investigate therapeutic effects of transurethral ureteroscopic pneumatic lithotripsy （TUPL）. Methods A retro-spective analysis was made on 89 cases of ureteral calculus treated with TUPL from September 2004 to March 2005. A Wolf 8/9.8F rigid uretero- scope and an EMS pneumatic ballistic lithotriptor were used. The probe was 1.0mm in diameter. The pulse setting was 300kPa. The fragmentation was conducted with single or multiple episode of treatment. Results The stone was pushed back to the renal pelvis in 3 cases and a conversion to extracorporeal shockwave lithotripsy （ESWL） was needed. The insertion of the ureteroscope was failed in 5 cases and a conversion to open surgery was required. The TUPL time was 2-25min （ mean 15 min） and the intraoperative blood loss was 3-15 ml（ mean 7 ml）. The stones were successfully fragmented on one session in 81 cases, the success rate being 92.3% （81/89）. The length of postoperative hospital stay was 3-7 d （ mean 4.5 d）. There were 8 cases of mucosal injury of the ureter and 2 cases of false passage, all of which were cured with double - J catheter in dwelling for lmonth. Follow - up examinations for1-10 months （ mean 4 months） showed stone clearance within 1 month and no ureteral stenosis or urinary infection. Conclusion Transurethral ureteroscopic pneumatic lithotripsy for the treatment of ureteral calculus is safe and effective.