输尿管阴性结石的CT泌尿系统造影诊断与钬激光治疗

CT urography diagnosis and Ho:YAG laser lithotripsy for ureteral radiolucent calculi

目的应用CT泌尿系统造影(CTU)及输尿管镜钬激光碎石技术诊断并治疗输尿管阴性结石,以提高输尿管阴性结石的诊治水平。方法对60例临床表现为肾绞痛、镜下血尿,B超检查提示或疑似输尿管结石,而腹部X线平片(KUB)未显示结石的患者行CTU检查,均被确诊为输尿管阴性结石,接受输尿管镜钬激光碎石治疗。结果 60例重建图像均清楚地显示输尿管全程,结石位于输尿管左侧42例,右侧18例;位于输尿管上段18例,中段15例,下段27例。输尿管镜钬激光碎石一次性成功44例;4例转膀胱镜钬激光碎石成功;3例行二次输尿管镜钬激光碎石获成功;5例结石直径<0.5cm者予药物排石治疗成功;另有4例患者第1次行输尿管镜或激光碎石治疗失败后转院治疗。结论 CTU输尿管重建诊断输尿管阴性结石快捷、准确,输尿管镜钬激光碎石术是治疗输尿管阴性结石较为理想的方法 。

Objective To use CT urography for diagnosis and Ho：YAG laser lithotripsy for treatment of the ureteral radiolucent calculi,so as to improve the diagnosis and treatment of ureteral radiolucent calculi.Methods A total of 60 patients,who had acute flank pain,hematuria and suspected ureteral stone on B-ultrasonography,yet with negative KUB,underwent CT urography,and they were diagnosed as having ureteral radiolucent calculi and were treated via ureteroscopy with Ho：YAG laser lithotripsy.Results CTU The CT urography in all the 60 cases clearly displayed the entire courses of ureter,including the location,size,and shape of the stones and the degrees of ureter dilatation.Forty-two calculi were located on the left side and 18 on the right side,19 at the upper part of the ureter,15 at the middle part,and 27 at the lower part.Forty-four cases were successfully fragmented after a single session of lithotripy,4 cases were fragmented by Ho：YAG laser lithotripsy via cystoscopy,and 3 cases were treated via ureteroscopy after a second Ho：YAG laser lithotripsy.Five cases with the diameters of calculi 0.5 cm were successfully treated with drug.Another 4 patients were transferred to other hospitals after a failed first session of Ho：YAG laser lithotripsy.Conclusion CTU is quick,accurate in diagnosing uretcral radiolucent calculi.Ureteroscopy with Ho：YAG laser lithotripy is an ideal treatment for the ureteral radiolucent calculi.（Shanghai Med J,2010,33：372-373）