ESWL失败输尿管上段结石的微创手术治疗

Mini - invasive surgery for upper ureteral stones treatment after ESWL failure

目的探讨ESWL治疗失败的输尿管上段结石的治疗方法。方法统计分析输尿管镜下气压弹道碎石，后腹腔镜输尿管上段切开取石、微创经皮肾穿刺取石治疗ESWL治疗失败的输尿管上段结石512例患者的临床资料。结果输尿管镜下气压弹道碎石组取石成功率为79．0％，微创经皮肾穿刺取石、输尿管镜下气压弹道碎石取石成功率100％。结论输尿管镜下气压弹道碎石创伤小，术后恢复快，是治疗输尿管上段结石的较为满意的治疗方法。微创经皮肾穿刺取石创伤小，取石成功率高，在结石靠近肾盂、并同侧肾结石和结石以下输尿管狭窄时应优先考虑。对于各种原因无法行ESWL、输尿管镜下气压弹道碎石及微创经皮肾穿刺取石或经治疗失败者，是后腹腔镜肾盂或输尿管取石术的绝对指征。同时输尿管结石较大或硬、嵌顿时间长或周围纤维或肉芽增生明显、完全性梗阻的孤肾结石也是其手术适应证。

Objective To investigate the ureatment of upper ureteral calculi after ESWL failure. Methods Aretro spective analysis was reviewed in 512 cases of upper ureteral calculi ＇after ESWL failure treated by ureteroscopy, retroperitoneal laparoscopy and percutaneous nephrolithotripsy were reviewed. Results Success rate of ureteroscopy was 79.0%. All retroperitoneal laparoscopy and percutaneous nephrolithotripsy cases were successful. Conclusion Mini - invasive surgery for the treatment of upper ureteral stones was safe, less traumatic and effective. Ureteroscopy was suitable for small ureteral stones. For some ureteral stones which were larger, close to UP J, companying with renal stones or failed ureteroscopy history, retroperitoneal laparoscopy and percutaneous nephrolithotripsy could increase the surgery success and stone -free rate.