输尿管镜下气压弹道碎石术治疗输尿管中下段结石(附126例报告)

Ureteroscopy and Swiss Lithoclast Pneumatic Lithotripter for the Treatment of Middle and Lower Ureteral Calculi

目的探讨输尿管镜下气压弹道碎石术治疗输尿管中下段结石的疗效。方法 2007年5月～2009年10月采用输尿管镜治疗输尿管中下段结石126例。在F5输尿管导管引导下进镜,同时置入气压弹道探条粉碎结石后留置双J管2～4周。结果手术时间12～38min,平均22min。4例输尿管中段结石因输尿管迂曲明显且息肉包裹紧密气压弹道碎石困难改行开放手术,2例输尿管中段结石冲入肾盂,1例因腺性膀胱炎黏膜病变严重患侧输尿管开口未找到,1例怀疑膀胱结核致输尿管进镜失败。9例碎石未成功,一次性结石清除率为92.3%(109/118)。术后住院时间6～9d。13例术后高热,术侧间歇性腰痛11例,术后均有轻度血尿。114例随访3～25个月,术后3个月复查B超51例轻度肾积水完全消失;37例中度肾积水中,23例减轻,3个月后仍有4例轻度积水;11例重度肾积水随访5个月,6例轻度积水,5例中度积水;9例轻度肾功能不全术后1个月恢复正常;3例急性肾功能衰竭术后3～5个月肾功能逐渐恢复正常。结论输尿管镜下气压弹道碎石术治疗输尿管中下段结石损伤小、安全可靠。

Objective To study the efficacy of ureteroscopic pneumatic lithotripsy for ureteral stones in the lower and middle ureter.Methods From May 2007 to October 2009,by using ureteroscopy we treated totally 126 patients with middle or lower ureteral calculi.Under the guidance of F5 catheter,we inserted the ureteroscope.A barometric pressure trajectory probe was placed simultaneously to smash the stones;afterwards,double-J tube was indwelt for 2 to 4 weeks.Results The procedure was completed in 12 to 38 minutes with a mean of 22.In 4 cases with calculi in the middle ureter,open surgery was carried out because of tortuous ureter and polyps formation.The operation was failed in 4 cases due to calculi moving into the renal pelvis（2 cases）,failure in detecting the ureteral orifice owning to cystitis glandular caused mucosal pathology（1 case）,and failure in inserting the endoscope because of suspected bladder tuberculosis.Lithotripsy was failed in 9 patients;one-session clearance rate was 92.3%（109/118）.The hospital stay in this series was 6-9 days.After the operation,13 patients had high fever,11 complained of intermittent lumber pain,all of them had mild hematuresis.Follow-up was achieved in 114 patients for 3 to 25 months.B-ultrasonography held in 3 months after the procedure showed that hydronephrosis disappeared in the 51 patients,improved in 23 of the 37 moderate patients（4 patients still had mild hydronephrosis at month 3）,and all the 11 severe patients（6 patients had mild hydronephrosis and the other 5 had moderate hydronephrosis at month 5）.Nine patients who had mild renal deficiency recovered in one month after the surgery,and 3 patients who showed acute renal failure recovered gradually in 3 to 5 months.Conclusion Ureteroscopy with pneumatic lithotripsy is effective,safe and less traumatic for middle and lower ureteral stones.