输尿管结石合并息肉的输尿管镜处理体会

Clinical experience of ureteroscopic lithotripsy in the treatment of ureteral calculi combined with polyps

目的:探讨输尿管镜弹道碎石取石术处理输尿管结石合并息肉的手术技巧。方法:应用膨宫机持续灌注生理盐水扩张法行弹道碎石取石术治疗25例输尿管结石合并息肉患者,采用各方向弹针均匀击石法碎石,术中均留置双J管1根。观察手术的疗效及并发症情况。结果:25例患者全部碎石成功,无一例中转开放手术,术中无输尿管断裂、撕脱和穿孔并发症发生,总手术时间为(31±5)min,碎石时间为(6.5±1.4)min,术后复查无结石残留;所有患者术后均得到3个月～1年随访,B超复查均未见结石残留及输尿管狭窄并发症发生。结论:保持术野清晰,有效暴露结石是输尿管镜处理结石合并息肉的关键,术中应用膨宫机持续灌注生理盐水扩张输尿管结合一定的弹道碎石技巧能提高碎石效率,疗效确切,有重要的临床应用价值。

Objective：To explore the surgical techniques of ureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi combined with polyps.Methods：Twenty-five patients with polyp surrounding ureter calculi underwent ureteroscopic pneumatic lithotripsy with swelling palace machine injecting normal saline to keep clear operation view,using certain pneumatic lithotripsy technique.Double J stent was invert before operation ended.Surgical effect and complications were observed and recorded.Results：All operations were successful with no case transferred to open surgery.No ureter breakage,avulsion and perforation occurred.Total operation time was（31.2±5.1）min.Time of stone removal was（6.5±1.4）min.Stone clearance rate were 100%（25/25）.All patients in two groups received 3 months to 1 year follow-up.B-ultrasound showed no residual stones and postoperative ureteral stricture occurred.Conclusions：It is the key point to maintain a clear operation field during ureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi combined with polyps.Intraoperative infusion of saline by swelling palace machine with some gravel techniques can favor stone removal,resulting in excellent surgical effect with important clinical value.