经输尿管镜气压弹道碎石术治疗输尿管下段结石的临床疗效分析

THERAPAUTIC EFFICACY OF URETEROSCOPIC PNEUMATO BALLISTIC LITHOTLAST FOR PATIENTS WITH DISTAL URETERAL STONE

目的:观察输尿管镜下气压弹道碎石治疗输尿管下段结石的临床疗效。方法:收集2006年10月至2010年10月重庆长安医院收治采用输尿管镜气压弹道碎石术治疗输尿管下段结石病例150例(男性106例、女性44例),根据结石直径分为<1 cm组127例及≥1 cm组23例,回顾性分析、对比其临床治疗效果。结果:结石直径<1cm患者碎石成功率(96.1%)显著高于≥1 cm组(91.3%)(P<0.01)。第1次输尿管镜碎石失败13例,其中输尿管镜无法前进至结石部8例(65.6%),碎石过程造成输尿管的损伤导致手术无法继续进行3例(24.6%),输尿管口扩张不足2例。第1次治疗失败的患者,再次输尿管镜碎石的成功率分别为80%(<1cm)和100%(≥1cm);而采用体外震波碎石术治疗成功率为100%(<1cm)和100%(≥1cm)。术后门诊随访次数分别为1.09次(<1cm)和1.19次(≥1cm)。150例患者中,9例(6%)发生输尿管镜碎石术相关并发症,泌尿道感染2例、血尿5例、剧烈疼痛1例、输尿管狭窄仅1例。结论:输尿管镜下气压弹道碎石术高效、微创、安全,可作为输尿管下段结石的首选治疗方法。如初步输尿管镜碎石手术失败,后续辅助治疗采用体外震波碎石术具有很好的疗效。

Objctive：To retrospectively estimate the therapeutic effect of ureteroscopic pneumato ballistic lithotripsy（UPBL） for distal ureteral stones.Methods：From October 2006 to October 2010,150 distal ureteral calculi were treated using UPBL.Results：The overall success rate was 96.1% for stones 1cm and 91.3% for stones 1cm.The causes of failed UPBL included inability to gain access to the stone in 8 cases,ureteral injury during the procedure in 3 cases,and failure to adequately dilate the orifice in 2 cases.Extracorporeal shock wave lithotripsy or UPBL once more were performed after initial failed attempt,and their success rate were 100% and 100% and 80% and 100%,respectively.Complications occurred in 9 patients（6%）,including urinary tract infection（in 2）,massive hematuria（in 5）,severe pain（in 1） and ureteral stenosis（only in1）.Conclusions：UPBL might be the treatment of choice for lower ureteral stones.ESWL was useful as an adjuvant treatment modality after failure of the initial UPBL attempt.