气压弹道碎石术治疗小儿输尿管中下段结石的体会

Ureteroscopy and pneumatic lithotripter for the treatment of ureter stones in children

目的探讨气压弹道碎石术治疗小儿输尿管中下段结石的临床效果及手术技巧。方法回顾性分析2009年11月至2012年1月间应用输尿管镜气压弹道碎石术治疗小儿输尿管中下段结石42例44侧的临床资料。结果本组有10例经筋膜扩张器扩张输尿管后方顺利置入输尿管镜，除1例Ⅱ期手术，均一次性成功，无1例中转开腹手术。手术时间为20～100min。所有病例随访1～18个月，未发现大出血、感染、输尿管、尿道狭窄等并发症。结论适度的筋膜扩张，合适的灌注压等均有利于提高输尿管镜气压弹道碎石术成功率，气压弹道碎石术是小儿输尿管中下段结石的理想治疗方法。

Objective To evaluate the efficacy and potential complications using ureteroscopy and pneumatic lithotrity for treatment of middle and lower ureteral stones in children. Methods Between November 2009 and January 2012, 42 cases （44 sides） with middle or lower ureteral stones underwent ureteroscopy and pneumatic lithotripter at this center. The clinical data were retrospectively analyzed. Results The stones were fragmented and discharged in 41 children after one episode of treatment. Ten patients underwent urethral dilation and were inserted the ureteroscope. None was converted into open surgery. The operation time ranged from 20 to 100 minutes （average time, 50 minutes）. No severe complications including obvious hematuria, infection, ureteral and urethral stricture were noted within 1-18 months of follow-up. Conclusions Ureteroscope pneumatic lithotrity is safe and feasible for treatment of middle and lower ureteral stone in children.