输尿管镜急诊治疗输尿管结石肾绞痛165例

Ureteroscopy for the Emergency Treatment of Acute Nephrocolic Caused by Ureteral Stone Obstruction: Report of 165 Cases

目的探讨输尿管镜急诊治疗输尿管结石梗阻引起持续、顽固性肾绞痛的临床效果。方法 2006年5月~2009年5月,采用Wolf F8/9.8、F7/8.5硬质输尿管镜,瑞士EMS气压弹道碎石装置,美国Trimedyne OmniPulse钬激光机,治疗输尿管结石急性梗阻肾绞痛165例。结果 160例在输尿管镜直视下1次操作成功,成功率97.0%（160/165）。6例术后复查B超、X线发现残留结石（3 mm以上）辅以ESWL治疗,结石粉碎;手术结石清除率96.2%（154/160）。结石粉碎,梗阻解除,肾绞痛未再发作。术后4~6周内结石全部排净。12例发生并发症：输尿管穿孔6例,采取单纯放置双J管保守治疗5例,开放手术治疗1例;泌尿系感染6例,其中1例感染性休克,治疗后痊愈。泌尿系感染6例随访6~9个月,3例结石复发,感染性休克患者半年后患肾萎缩,功能减退。结论输尿管镜治疗输尿管结石引起的急性梗阻具有快速、安全、高效,对顽固、持续肾绞痛者立竿见影。

Objective To observe the efficacy of ureteroscopy for continuous nephrocolic caused by acute ureteral stone obstruction. Methods Between May 2006 and May 2009,165 cases of acute ureteral stone obstruction with nephrocolic were treated by using F8/9.8 or F7/8.5 Wolf rigid ureteroscope with Trimedyne OmniPulse Ho∶YAG or EMS pneumatic lithotripter（Switzerland） in our hospital. Results Among the 165 patients,the operation was successfully completed in one session in 160（97.0%） cases.Postoperative reexamination with B-ultrasonography and X-ray recovered residual stones（3 mm in diameter） in 6 cases,who were then cured with ESWL.The rate of stone clearance was 96.2%（154/160）.In 4 to 6 weeks after the operation,all the patients showed stone clearance without complaining nephrocolic again.Postoperative complications included ureteral perforation in 6 cases（cured by conservative therapy with double-J tube in 5 cases,and open surgery in the other）,and urinary infection in 6 cases,including one case of infectious shock.The 6 patients with urinary infection were cured and followed up for 6 to 9 months,3 of them had recurrent stones;the one who had infectious shock developed renal atrophy and failure in 6 months after the treatment.Conclusions Ureteroscopy is a fast,safe,and effective treatment for acute obstruction of ureteral stones.It is an optimal choice for patients with continuous nephrocolic.