输尿管镜单通道拦截网气压弹道碎石治疗输尿管上段结石45例分析

Treatment of upper ureteral stones with N-Trap stone extraction combined with pneumatic litho- tripter in single channel under ureteroscopy

目的探讨输尿管镜下单通道N—Trap拦截网结合气压弹道碎石治疗输尿管上段结石的临床疗效。方法采用输尿管镜下单通道置入N—Trap拦截网和气压弹道碎石系统治疗输尿管上段结石45例。结石横径为7～13mm，纵径为10—20mm。结果45例中43例通过拦截网，气压弹道击碎结石小于4mm，未出现结石移位。2例未通过拦截网改用钬激光碎石，其中1例有大块结石冲入肾盂，术后体外冲击波碎石（ESWL）。43例平均手术时间38min；未出现输尿管穿孔和明显的出血。结论单一通道置入N．Trap拦截网和气压弹道碎石系统创伤小，减少了结石上移及大块残石的发生，使拦截网的使用方便实用，是值得临床推荐的一种治疗方法。

Objective To evaluate the effectiveness of ureteroscopy and N-Trap,a nitinol ureteral occlusion device, combined with pneumatic lithotripter in single channel for managing upper ureteral cafculi. Methods Forty-five patients with upper ureteral calculi were treated with N-Trap combined with pneumatic lithotripsy in single channel under ureteroscopy. The transverse diameter of the calculi was 7 - 13 mm and the vertical length was 10 -20 mm. Results Operations succeeded in 43 cases,in which stones were shattered with no shifting by pneumatic lithotripter（ diameter 〈 4 mm）. The mean operation time was 38 min. N-Trap failed to pass through the stones and holmium laser were used in 2 cases, in which 1 un- derwent postoperative extracorporeal shock wave lithotripsy due to mass stone in renal pelvis. None of the 43 patients had complications of perforation or marked hemorrhage. Conclusion N-Trap combined with pneumatic lithotripsy for treating upper ureteral stones is a simple and safe strategy with minimal invasion and low incidence of residual fragments, which is worth recommending in clinical practice.