ESWL与输尿管镜碎石联合处理上尿路结石

Combination of ESWL and Ureteroscopic Lithotripsy in the Treatment of Upper Urinary Tract Calculi

目的:探讨对部分上尿路结石采用ESWL与输尿管镜碎石联合处理的方法。方法:对70例上尿路结石患者采用ESWL与输尿管镜下钬激光碎石(URS)联合交替治疗。其中输尿管结石48例,肾结石22例。结果:结石总排净率为91.4%(64/70),其中输尿管结石排净率为95.8%(46/48),肾结石排净率为81.8%(18/22)。3例治疗失败,其中1例输尿管结石因输尿管狭窄无法入镜;另2例肾结石,1例因交替治疗次数过多中途停止治疗,1例因结石硬度过大ESWL不佳,均改为PCNL术。结论:ESWL与URS联合交替进行的疗法处理上尿路结石,避免了创伤性治疗,扩大了ESWL治疗范围,降低了URS手术难度,缩短了URS操作时间,提高了结石排净率,患者创伤微小、恢复快、并发症少,是治疗上尿路结石,特别是部分复杂性上尿路结石较理想的方法之一。

Objective： To investigate the treatment of part of the upper urinary tract calculi with ESWL and URS oombination. Methods： From 2007,70 patients in our hospital with upper urinary tract calculi were treated by extraeorporeal shock wave lithotripsy （ESWL） and ureteroscopic holmium laser lithotripsy （URS） Joint ahernate ly. Among them, 48 patients with ureteral calculi, 22 cases of renal calculi. Results： The total stones free rate was 91.4% （64/70）, in which ureteral stones free rate was 95. 8% （46/48）, kidney stones free rate was 81. 8% （18/22）. 3 cases of treatment failure, 1 case of ureteral stones, not into the Ureter because of ureteralstenosis, 2 cases of kidney stones, including a case of way too many times to stop alternative therapy treatment, the other with ESWL for stones too poor hardness, were converted to PCNL surgery. 3 cases with residual stones, including one case of ureteral stones, two cases of kidney stones. Conclusions：ESWL and URS treatment of upper urinary tract stones combined avoids the trauma, and expanded the scope of ESWL treatment, reduces the difficulty of URS surgery to shorten the operation time and increase the stone free rate. Trauma patients are small, quick recovery and fewer complications. It is the treatment of urinary calculi, especially in some complex upper urinary tract stones ideal methods.