输尿管镜下NTrap拦截网配合超声弹道碎石治疗输尿管上段结石

Treatment of upper ureteral stones with NTrap stone extraction combined with ultrasonic and pneumatic lithotripter under ureteroscopy

目的探讨输尿管镜下NTrap拦截网配合超声弹道碎石治疗输尿管上段结石的临床疗效。方法采用输尿管镜下NTrap拦截网配合第三代超声弹道碎石系统治疗输尿管上段结石20例。结石横径为5～13mm，纵径为6～20mm。其中9例先采用钬激光将结石适当打碎后再采用三代超声碎石。结果所有结石都被拦截网固定后碎石，一次性碎石成功率95％（19／20），1例术后结合体外冲击波碎石（ESWL）治愈；平均手术时间46min；估计术中平均失血量为10mL。术中无1例输尿管穿孔和明显的出血。结论拦截网将结石适当固定是碎石成功的关键，与第三代超声弹道碎石清石系统联合应用具有结石清除率高、创伤小、并发症少等特点，是值得临床推荐的一种治疗方法。

Objective To evaluate the effectiveness of NTrap （nitinol ureteral occlusion device） stone extraction combined with ultrasonic and pneumatic lithotripter under ureteroscopy for managing upper ureteral stones. Methods 20 patients with upper ureteral stones were treated with NTrap combined with ultrasonic lithotripsy under ureteroscopy. The transverse diameter of the stones was 5 - 13 mm and the vertical length 6 -20 mm. Of the 20 cases, 9 were treated with holmium laser lithotripsy firstly and then with ultrasonic and pneumatic lithotripter. The mean operation time was 46 min and mean blood loss 10 mL. Results 95% （19/20） stones were fragmented in one session of treatment. In 1 case the stones were pushed upward and the patients received extracorporeal shock wave lithotripsy （ESWL） after operations. No lithiasic fragments were observed in the imaging tests of all cases one month after surgery. None of the 20 patients had complications of perforation or marked hemorrhage. Oonclusion Appropriate fixation of the stones by NTrap is the key to success. NTrap combined with ultrasonic lithotripsy for upper ureteral stones is characterized by high efficacy and safety, lower incidence of residual fragments, lower reoperation rate and minimal invasion. This therapeutic method is worth recommending in clinical practice.