输尿管镜碎石失败的原因分析与处理

Cause analysis and handling of ureteroscopic lithotripsy failure

目的:分析输尿管镜下碎石术失败的常见原因及处理。方法:对27例应用输尿管镜下气压弹道碎石或钬激光碎石术治疗输尿管结石失败的病例进行分析。结果:输尿管管腔炎性息肉形成和狭窄,无法窥见结石7例,输尿管严重迂曲,进镜困难4例,输尿管损伤出血,视野不清5例,均改开放手术切开取石治愈。结石上移进入肾盂肾盏11例,其中,3例行经皮肾镜取石(PCNL)治疗治愈,8例留置双J管后经体外冲击波碎石(ESWL)治愈。结论:熟练的技术操作及严格掌握手术适应证是减少输尿管镜技术失败的关键,配合其他腔内碎石技术,可提高取石成功率。

Objective： To analyze the causes and handling of ureteroscopic lithotripsy failure. Methods： Twenty-seven cases of failed ureteroscopic pneumatic lithotripsy or holmium laser lithotripsy for ureteral stones were analyzed. Results： Ureteral lumen inflammatory polyps formation and stenosis without glimpse of the stone occurred in 7 cases and difficulty of entry of ureteroscope caused by severe tortuous ureter was observed in 4 cases. Poor visibility caused by ureteral injury bleeding occurred in 5 cases, all of which were cured after changing to open surgery. Stones moved into the renal pelvis in 11 cases, of which 3 cases were cured by PCNL and 8 cases were cured by ESWL after placing double-J tube. Conclusion： Skilled operations and strict control of surgical indications is the key to reduce failure of ureteroscopy. The concurrent employment of other lithotripsy techniques can improve the success rate of stone removal.