输尿管镜气压弹道碎石术治疗ESWL术后输尿管石街的临床分析

Clinical Analysis of Ureteroscopy Pneumatic Ballistic Lithotripsy in Treating Ureteral Steinstrasse after ESWL Operation

目的总结输尿管镜气压弹道碎石术治疗体外冲击波碎石(ESWL)术后输尿管石街的临床经验。方法回顾性分析2003年3月至2011年3月期间我院采用输尿管镜气压弹道碎石术治疗的124例ESWL术后输尿管石街患者的临床资料特点与临床疗效。结果 87例手术患者一次取尽结石,33例患者在碎石过程中部分碎石冲入肾盂,再次ESWL后排出,4例行二次手术取尽结石;不同性别患者的临床有效率和血尿持续时间无明显差异(P>0.05),但男性患者的手术时间和并发症发生率则明显高于女性患者(t=1.9901,P<0.05;χ2=16.3294,P<0.01)。结论输尿管镜气压弹道碎石术是ESWL术后输尿管石街形成的首选治疗方法之一,但男性患者的手术时间和并发症发生率明显高于女性,这与男女患者的尿道结构和长度不同有关。

Objective To summarize the clinical experience of ureteroscopy pneumatic ballistic lithotripsy in the treatment of ureteral steinstrasse after extracorporeal shock wave lithotripsy （ESWL） operation. Methods The clinical data and curative effect of 124 patients with ureteral steinstrasse after ESWL operation in our hospital from March 2003 to March 2011 were analyzed retrospectively. Results 87 patients had one-time calculi free; 33 patients had calculi drift to pelvis during lithotripsy, and calculi were discharged after re-ESWL. 4 cases underwent second operation. The differences of clinical efficiency and hematuria duration time between patients with different gender were not statistically significant （P〉0.05）; but the male patients had longer surgical time and higher complication occurence rate compared with the female patients （t = 1.9901, P 〈0.05;χ2 = 16.3294, P 〈0.01）. Conclusions The method of ureteroscopy pneumatic ballistic lithotripsy is the first choice in the treatment of ureteral steinstrasse after ESWL operation. The male patients has longer surgical time and higher complication occurence rate compared with the female patients, which is related to the difference of structure and length of the urethra between male and female patients.