合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石疗效观察(附138例报告)

Clinical observation for EWSL treatment on urinary negative calculi by atropine retrograde urography combined with intravenous pyelography location

目的:探讨合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石的临床效果。方法:术前138例患者经B超、IVU、CT检查确诊输尿管阴性结石。采用IVU联合应用阿托品针、碘海醇针合剂经输尿管导管持续微泵泵入,行逆行造影(RGU)辅助,经X线定位后,明确结石的部位及大小后行ESWL治疗。留置输尿管导管综合排石治疗3～5天,观察临床碎石效果。结果:本组138例患者经1次ESWL治疗后2～4周,121例(87.8%)结石完全排净,第2次ESWL治疗结石排净10例(7.2%),第3次ESWL治疗结石排净2例(1.4%);2例(1.4%)形成"石街",需行输尿管镜取石;无效3例(2.2%),行开放手术取石,证实结石有炎性肉芽包裹。结论:合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石临床疗效确切,术后留置输尿管导管逆行灌注冲洗利于排石。

Objective：To observe the clinical effects of extracorporeal shock wave lithotripsy（EWSL） by atro： pine retrograde urography combined with intravenous pyelography（IVU） location in treatment of urinary negative calculi. Methods： 138 cases were diagnosed ureteral stones by B-ultrasound, IVU and CT. All the cases combined IVU with atropine needles, continuous pumped iohexol needle mixture through the ureteral catheter micro- pump, retrograde urography （RGU） to assist clearly the stones X-ray location and size before ESWL treatment. Then the cases retained the ureteral catheter and consolidated treatment of the row of stone 3-5 days to observe the clinical effects. Results： Among the 138 cases, 121 patients （87.8%） completely drained after a second 2-4 weeks after the first ESWL treatment; 10 patients （7.2%） completely drained by the second ESWL treatment; 2 pa- tients （1.4 % ） completely drained by the third ESWL treatment; 2 cases （1.4% ） formed a ＂stone street＂ and nee- ded to line transurethral ureteroscopic lithotripsy （URL） ; 3 cases （2.2%） were ineffective and needed the opened stone surgery, which cases were confirmed stones wrapped by the inflammatory granulation package. Conclusions： EWSL treatment on urinary negative calculi by atropine retrograde urography combine with intravenous pyelogra- play location is curative effect. Retrograde perfusion washing help stone drain after ESWL.