输尿管镜碎石取石术失败原因分析

Clinical analysis of reasons of failure ureteroscopy operation for ureteral calculus

目的:探讨输尿管镜治疗输尿管结石失败的原因及预防、处理方法。方法:回顾分析120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:120例共进行131次单侧输尿管镜手术,其中112次手术取尽单侧结石,成功率85.5%。取石失败有18例,其中4例为找不到输尿管开口,6例为输尿管狭窄入镜困难,6例为结石上移至肾盂肾盏,2例为假道形成。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。失败后应根据情况改用体外冲击波碎石术(ESWL)或开放手术治疗。

Objective ：To analyze the reasons of failure ureteroscopy operation for ureteral calculus and to explore the way to prevent and handle failure ureteroscopy operation. Methods： Reviewed the clinical data of 120 patients with ureteroscopy operation for ureteral calculus.Failure operation in these cases were analysed respectively. Results：Total 131 ureteroscopy operations were performed in 120 cases. 112 operations were successful in removeing the lateral ureterolith （85.5%）. 18 cases were failure, including the difficult of searching the ureteral orifice （4 cases）, the difficult of ureteroscopy insert （6 cases）,the upward pushing of the stone （6 cases）, false passage shaped （2 cases）. Conclusion：The main reasons of failure ureteroscopy operatin are difficulty of ureteroseopy 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 operationfor revoming ureterolith. ESWL and open surgery are the suitable remedy measures according to the failure reason.