输尿管镜气压弹道碎石术治疗复杂性输尿管结石

Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi

目的 探讨输尿管镜气压弹道碎石术治疗复杂性输尿管结石的疗效.方法 采用输尿管镜气压弹道碎石术治疗复杂性输尿管结石56例,其中输尿管上段结石15例,中下段结石41例,体外冲击波碎石术（ESWL）失败25例,合并高热8例.结果 56例患者中,中下段结石均一次完全粉碎,成功率100.0%（41/41）.上段结石一次完全粉碎10例,成功率66.7%（10/15）.3例结石术中移位至肾脏,后辅以ESWL治疗1～2次,1例进镜困难终止手术,1例因输尿管穿孔改行开放手术.术后4周结石总清除率87.5%（49/56）.8例合并高热者均急诊手术,7例一次结石粉碎成功,1例结石移位至肾脏,但梗阻均经手术得以解除,术后高热停止.输尿管穿孔发生率为1.8%（1/56）.结论 输尿管镜气压弹道碎石术治疗复杂性输尿管结石安全、有效.

Objective To evaluate the therapeutic efficacy of ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi. Methods Clinical data of 56 cases with complicated ureteral calculi who were treated with ureteroscopic pneumatic lithotripsy was reviewed. Among them 15 cases were proximal ureteral calculi,41 cases were middle and distal ureteral calculi. Treatment by extracorporeal shockwave lithotripsy （ESWL） failed in 25 cases,8 cases complicated with fever. Results In 41 cases with middle and distal ureteral calculi, successful lithotripsy was achieved after the first treatment session,the success rate was 100.0% （41/41）. In 15 cases with proximal ureteral calculi ,successful lithotripsy was achieved in 10 cases after the first treatment session,the success rate was 66.7%（l0/15）. Calculi migrated to kidney in 3 cases who treated by ESWL for 1-2 times. The failure was due to ureteral kink in 1 case and due to ureteral perforation that required surgical repair in another case. Forty-nine cases were calculi-free after 4 weeks,the calculi-free rate was 87.5%（49/56）. Emergency operation was performed in 8 cases complicated with fever. Successful lithotripsy was achieved after the first treatment session in 7 cases. In one patient,calculi migration occurred. Within all 8 cases obstruction was released and fever was allayed after operation.The complication rate was 1.8% （1/56）. Conclusion Ureteroscopic pneumatic lithotripsy for treatment of complicated ureteral calculi is a safe and effective method.