输尿管镜下气压弹道碎石术治疗输尿管结石

Treatment of Ureteral Calculus with Transurethral Ureteroscope Pneumatic Lithotripsy

目的:探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法:回顾性分析我院2003年9月至2009年8月应用输尿管镜气压弹道碎石术对620例输尿管结石的治疗情况。输尿管上段结石113例,中段结石229例,下段结石177例,体外冲击波碎石后失败67例,体外冲击波碎石后石街形成34例。根据具体情况采用德国Wolf F9.8输尿管硬镜和瑞士EMS气压弹道碎石机单次或连续击发的方式碎石。结果:碎石时间8～35 min,平均15.5 min,术中出血3～20 ml,平均7 ml。术后住院时间3～7 d,平均4.5 d。602例一次碎石成功,成功率97.0%(602/620)。11例结石冲回肾盂,改体外冲击波碎石治疗,5例插输尿管镜碎石失败,2例术中发现伴输尿管肿瘤,均改开放手术。38例输尿管黏膜损伤,8例形成假道,均置双J管1个月后痊愈。602例随访1～18个月,平均6个月。1个月内结石全部排净,未出现输尿管狭窄、尿路感染等并发症。结论:输尿管镜下气压弹道碎石术治疗输尿管结石方法安全、疗效可靠。

Objective：To investigate the therapeutic effects of transurethral ureteroscope pneumatic lithotripsy（TUPL）.Methods：620 cases with ureteral calculi treated with TUPL from Sep.2003 to Aug.2009 were studied reyrospectively.There were 113 case with upper ureteral stone,229 cases with middle and 177 cases with lower ureteral stone,34 cases ureteral stone street.Results：The operation time was 8～35min（mean,15.5min）,The intraoperative blood loss was 3～20ml（mean,7ml）.The length of postoperative hospital stay was 3～7d（mean,4.5d）.602 cases were successfully fragmented on one session in 97.0%（602/620）.TUPL caused mucosal severe injury of ureters（38 cases）,perforation（8 cases）,stone back to pelvis（11 cases）,failure（7 cases）.Followed up 1～18 months（mean,6months）,602 cases were all stonefree.Conclusion：TUPL for the treatment of ureteral calculus is safe,effective,and has less injury and complications than other treatment methods.