输尿管镜气压弹道碎石术常见并发症原因分析

Causes analysis of common complications of ureteroscopic pneumatic lithotripsy

目的回顾性评价输尿管镜气压弹道碎石术常见并发症的引起原因、对策及预防措施。方法分析永川区人民医院2002年9月至2008年2月136例输尿管镜气压弹道碎石术治疗输尿管结石患者的资料。男83例,女53例;年龄20～61岁,平均45.2岁。结石位于输尿管上段52例,中段43例,下段41例。结果输尿管上段结石碎石成功率为82.6%(43/52),3例加行体外震波碎石术;输尿管中下段结石碎石成功率为95.2%(80/84)。操作失败5例,输尿管损伤7例,其中,输尿管穿孔3例,输尿管黏膜下假道2例,输尿管黏膜撕脱1例,输尿管部分断裂1例,经留置输尿管支架管均痊愈。感染伴发热2例,腰痛5例,对症治疗后好转。结论输尿管镜气压弹道碎石术创伤小、成功率高,术中操作技巧的提高可减少并发症发生,增加结石排净概率。

Objective To retrospectively evaluate the clinical experience of the causes and management of common complications of ureteroscopic pneumatic lithotripsy. Methods 136 cases of uteteral calculi from September 2002 to February 2008 in our hospital were reported（83 men and 53 women,age ranged 20-61 years,mean age 45.2 years）. 52 patients had calculi in the upper ureter,43 in the middle part and 41 in the lower ureter. Results The o- verall comminution rate in the upper ureter was 82.6 % （43/52 cases）, 3 cases were followed by ESWL,The overall eomminution rate in the middle and lower part ureter was 95.2 %（80/84）. 7 （5.1 %）cases complicated with ureter injury, among which 3 cases had perforation, 2 cases had urethral submucosa pesudocanal and 1 case had ureteral mucosa evulsion,all reeoveried after placement of ureteral stents. Lumbago was found in 5 cases and infection in 2 cases. Conclusion Ureteroscopie pneumatic lithotripsy is an effective method for treating ureteral calculi, with advantage of high efficacy, safety, minimal invasion and simplicity of performance. To raise operating technique could reduce complications and raise success ratio.