腔镜下球囊导管辅助钬激光治疗输尿管中段和上段结石76例

Endoscopic Lithotripsy with Holmium∶YAG Laser Combined with Balloon Catheter for Middle and Upper Ureteral Calculi:Report of 76 Cases

目的探讨在输尿管镜下碎石术中使用输尿管球囊导管阻止结石移位的效果。方法 2010年5月～2011年8月,对76例输尿管中段和上段结石,使用Wolf F8/9.8输尿管硬镜,F4输尿管球囊导管阻止结石移位,国产腔内灌注泵灌注使视野清晰,65 W钬激光碎石。结果 71例一次碎石成功,成功率为93.4%(71/76),术后2～8周拔除双J管时复查B超或泌尿系平片检查,均无输尿管结石残留。5例未成功:3例上段结石上移到肾盂(1例为钬激光击中球囊致球囊破裂后结石移位,2例放球囊前结石已经被冲入肾盂)改ESWL治疗,1例因输尿管穿孔、1例因输尿管开口变异无法上插输尿管镜改开放手术。结论输尿管镜钬激光碎石术中使用输尿管球囊导管,可以阻止结石移位。

Objective To investigate the efficacy of ureteral balloon catheter for preventing stone displacement during endoscopic lithotripsy with holmium： YAG laser. Methods From May 2010 to August 2011, totally 76 patients with middle and upper ureteral calculi received endoscopic lithotripsy in our hospital. With a Wolf F8/9. rigid ureteroseope, we performed lithotripsy with a 65 W holmium： YAG laser. A F4 balloon catheter was used to prevent stone displacement. To keep the surgical field clear, we employed a domestic intracavitary perfusion device. Results The one-session success rate of the procedure was 93.4% （71/76）. Reexamination by B-uhrasonography or KUB was made in 2 to 8 weeks after the operation, when double-J tube was removed; no residual stones were found. The procedure was failed in 5 patients because of stone displacement to the renal pelvis （ three cases ,laser- caused balloon rupture in one case, and stone displacement before inserting the balloon catheter in the other two; all the three patients were converted to ESWL ）, ureteral perforation （ one case, converted to open surgery ）, or failure in placing ureteroscope due to abnormal ureteral orifice （one case, converted to open surgery）. Conclusion Balloon catheter can prevent stone displacement in endoscopic lithotripsy with holmium： YAG laser.