经尿道输尿管镜下气压弹道碎石术治疗输尿管结石

Transurethral ureteroscopic pneumatic lithotripsy for ureteral calculi

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法输尿管镜下气压弹道碎石术治疗输尿管结石56例,尿管上段结石3例,中段结石32例,下段结石21例中结石位于左侧30例,右侧25例,双侧1例。结果56例输尿管结石粉碎53例(94.6%),1例结石移动至肾盂未完成手术,1例置镜失败而改行开放手术,1例发生输尿管下段穿孔,经放置双J管内引流后改行ESWL治疗。30例(53.6%)术后有肉眼或镜下血尿,所有病例无尿路感染、输尿管黏膜剥脱、撕裂及狭窄等严重并发症。结论输尿管镜直视下气压弹道碎石术治疗输尿管结石,疗效确切、安全、组织损伤小,并发症少,可作为输尿管中段和下段结石的首选治疗方法。

Objective To investigate the efficacy of pneumatic lithotripsy under ureteroscopy for the treatment of ureteral stones. Methods Pneumatic lithotripsy under ureteroscopy was performed to treat 56 cases of ureteral calculi, including 3 cases of upper ureteral calculi, 32 cases of middle calculi and 21 cases of lower calculi. Of the 56 cases, 30 had calculi in the left side 25, the right side and 1 in both sides. Results The stones in 53 of the 56 cases were crushed successfully （94.6%）. In 1 case and the stones moved to renal pelvis. In another case the ureteroscope failed to be inserted into the ureter, then open surgery was performed. In 1 case the lower ureteral perforation happened and double-J stent drainage had to be placed. 30 cases （53.6%） had the macro or microscopic hematuria after operation, but no patient had urinary tract infection, ureteral mucosa avulsion, tearing or serious complications such as stenosis. Conclusion It is a precise and safe procedure with less tissue injury and complication to treatureteral caluli with pneumatic lithotripsy under ureteroscope, which can be regarded as the preferred method of treatment for middle and lower ureteral calculi.