难治性输尿管结石的腔内分期治疗

Staged endoscopic treatment of refractory ureteral calculus

目的评估腔内分期治疗难治性输尿管结石安全性和临床疗效。方法腔内分期治疗难治性输尿管结石患者18例。男11例，女7例。年龄2～65岁，平均32岁。双侧结石2例。结石位于输尿管上段11侧、中段6侧、下段3侧。结石直径0．4～1．6cm，平均0．9cm。患者因输尿管扭曲、先天性狭细无法行输尿管镜下碎石取石或体外冲击波碎石失败而采取腔内分期治疗。18例第1次手术均被迫单纯留置输尿管内支架或经皮肾造瘘；第2次或第3次再行腔内治疗处理结石。结果第1次手术后40～50d行第2次手术，结石取净13例；第2次手术后50～60d行第3次手术，结石取净5例。18例均无术中和术后并发症。18例取出内支架后随访6个月，未发现结石复发。结论采取腔内分期治疗难治性输尿管结石安全可行。

Objective To investigate the feasibility, safety and clinical efficacy of staged endoscopic treatment for refractory ureteral calculus. Methods Eighteen refractory ureteral calculus cases （11 males and 7 females） treated with staged endoscopic treatment were retrospectively analyzed. The mean age of the patients was 32 years （range 2-65 years）. Of the 18 cases, 2 had bilateral ureteral calculi. Of the 20 ureteral calculi, 11 were in the upper, 6 were in the middle and 3 in the lower part of ureter. The mean diameter of the calculi was 0.9 cm （range 0.4-1.6 cm）. Staged endoscopic treatment was offered to patients because of failure of ureterscopic lithotripsy or extracoporeal shockwave lithotrispy caused by uretreal twist or congential narrow. For all the cases, it was hard to completely clear all the stone load and ureteral stents or percutaneous nephrostomy were performed to drain the kidney in the first session. Then, the calculi were removed by endoscopic manipulations in the second or third session. Results Thirteen patient＇s calculi were completely cleared in the second sessions 40-50 d after the first operation. The other 5 cases had to accept the third session 50-60 d after the second operations. There was no intra- or post-operative complication in all cases. During the 6 months＇ follow-up, there was no sign of recurrence. Conclusion Staged endoscopic treatment is a feasible and safe method and has high efficiency in the management of refractory ureteral calculi.