体外冲击波碎石在治疗结石形成导致双J管滞留中的价值

ESWL for Calculi-caused Double-J Tube Retention

目的探讨体外冲击波碎石术在在治疗结石形成导致双J管滞留的应用价值。方法 2003年1月～2012年1月对31例经皮肾镜气压弹道碎石术、输尿管镜检查及碎石术后结石形成导致双J管滞留者采用体外冲击波碎石,电压从6kV开始,根据患者耐受力逐渐增加至7 kV,冲击次数3000～3500次,时间约90 min。冲击从膀胱端开始,依次为输尿管、肾盂,重点冲击肾盂输尿管连接部,当透视发现结石与双J管分离且结石直径<3 mm治疗结束。结果 22例1次ESWL后双J管顺利拔出;5例2次ESWL后拔出;2例2次ESWL后仍不能拔出,改行输尿管镜后顺利拔出;2例由于结石较大且合并肾盂结石改行微通道经皮肾镜取石术后顺利拔出双J管。31例术后随访6个月,26例无结石复发,5例复发肾结石(4例行排石药物治疗,1例行体外冲击波碎石治疗,结石均顺利排出)。结论对于结石形成导致双J管滞留,ESWL是一种简单、安全、有效的治疗方法。

Objective To study the efficacy of ESWL for double-J tube retention caused by renal stones formation. Methods Since January 2003 to January 2012, 31 patients developed double-J tube retention because of renal stones formation after percutaneous nephrolithotomy with pneumatic lithotripsy and ureteroscopy. We performed ESWL on all the patients with the voltage started from 6 kV, which could be increased to 7 kV depending on the tolerance of the patients, and 3000 - 3500 shock waves were delivered within 90 min （started from the bladder, followed by the ureter and renal pelvis, and focused on the ureteropelvic junction）, until the double-J tube was separated from the stones, and the stones were smaller than 3 mm in diameter. Results The double-J tube was removed after one session of ESWL in 22 patients, and two sessions in 5 patients. In the other 4 patients, we could not remove the double-J tube even after two sessions of ESWL, therefore ureteroscopy （2 cases） or minimally invasive PCNL （2 cases, who showed large stones complicated with renal pelvic calculi） was carried out. The patients were followed up for 6 months, during which 5 patients had recurrent renal calculi, and then were cured by medication （4 cases） or ESWL （ 1 case）. Conclusion ESWL is a simple, safe, and effective method for double-J tube retention caused by renal stones formation.