输尿管结石3种治疗方法的比较

A comparative study of 3 various means for the treatment of ureteral calculi

目的探讨输尿管结石治疗方法的选择。方法对经体外冲击波碎石(ESWL)、输尿管镜下钬激光碎石术及输尿管切开取石术3种方法治疗的180例输尿管结石患者疗效进行比较。结果ESWL118例,碎石率为86.4%,输尿管镜下钬激光碎石50例,一次碎石率为92%,手术切开输尿管取石12例,取石成功率为100%。输尿管镜失败改手术切开取石4例,占8%;ESWL失败改手术切开取石或输尿管镜下钬激光碎石45例,占38.1%。结论上段输尿管结石宜采用ESWL,该治疗应积极处理石街、控制感染和最大限度减轻医源性肾功能损害;中、下段输尿管结石宜采用输尿管镜下钬激光碎石术,该治疗需熟练的内镜操作技术;对于复杂性输尿管结石,开放手术仍是可供选择的重要的治疗手段。

Objective To study and evaluate the three treatments of ureteral calculi. Methods The treatment of 180 cases of ureteral calculi were compared by ESWL , ureteroscopic Ho：YAG laser lithotripsy and open surgery. Results 118 cases were treated by ESWL （65. 5% ） , 50 cases were treated by ureteroscopic Ho：YAG laser lithotripsy （27. 8 % ） , 12 cases were treated by open surgery （6. 7% ） . 4 cases （8%） were obliged to accept the open surgery because the ureteroscopic Ho ： YAG laser lithotripsy was failure . 45 cases （38. 1% ） were obliged to accept ureteroscopic Ho ： YAG laser lithotripsy or open surgery because of ESWL failure . Conclusion ESWL was more suitable for the upper ureteral calculi , stone street after ESWL should be well taken care of and inflammation should be well controlled . ureteroscopic Ho：YAG laser lithotripsy was more suitable for middle lower ureteral calculi , skilled technique is needed for ureteroscopic Ho：YAG laser lithotripsy. But the open surgery is still of great use for complicated stone .