输尿管结石性肾绞痛的治疗方法选择:附90例报告

Ninety case reports on treatment for ureteral calculus and renal colic

目的探讨输尿管结石性肾绞痛的有效处理方法。方法回顾性分析我科90例输尿管结石性肾绞痛的综合治疗情况,手术治疗+ESWL(体外冲击波碎石)组68例,其中12例超声诊断输尿管第三狭窄结石患者行ESWL,56例行急诊输尿管镜手术。保守治疗组22例肾绞痛患者行保守治疗。结果手术治疗+ESWL组病例治疗效果满意,12例行ESWL患者中8例结石排净,4例碎石后仍有疼痛,经输尿管镜治疗后疼痛消失。56例经输尿管镜手术患者,48例行输尿管镜下弹道碎石取石后双J管引流成功,5例由于输尿管水肿、狭窄导致输尿管镜不能通过,行输尿管导管外引流,其中2例行ESWL,3例引流一周后再次输尿管检查+弹道碎石成功,3例肾绞痛并妊娠,行椎管内麻醉后输尿管镜检查+双J管内引流。保守治疗组22例肾绞痛患者不愿意手术行保守治疗,疼痛反复发作,中西药治疗效果欠佳。结论处理输尿管结石性肾绞痛应根据具体不同的情况进行选择,输尿管镜手术处理输尿管结石性肾绞痛安全有效,可迅速解除患者痛苦,并发症少,在妊娠期也是安全的。

Object The purpose of present study is to develop a facilitated minimal invasive therapy with high stone-free rate, relieving the pain of patients with renal colic. Method We retrospectively investigated 90 cases that had ureteral calculus and renal colic. Of 78 patients as the operation and ESWL groups, 56 patients had upper or middle ureteral calculus or dilatation, and underwent emergency ureteroscopic lithotripsy. Another 12 cases with ureteral calculus in the third narrowed segment underwent extraeorporeal shock wave lithotripsy. As the control group, 22 renal colic patients were administrated conservative therapy. Results The result of Surgery ＋ the ESWL group of 78 cases was satisfying, narrow section of ureteral stones the 12 cases of diagnosised by B ultrasound underwent ESWL, 56 cases underwent ureteral check ＋ ballistic lithotripsy, 48 cases underwent ureteral check ＋ lithotripsy double J-tube drainage, five cases underwent ureteral catheter drainage because of ureteral edema and narrow. Three cases of renal colic and pregnancy, underwent ureteroscopy ＋ double J tube internal drainage. In conservative treatment group, 22 cases of renal colic patients refused surgery and suffered from recurrent pain, Chinese and Western medicine treatment is ineffective. Conclusions After diagnosed by B-uhrasonography and KUB examination, patients with ureteral calculus and renal colic should treated by ureteroscopie therapy, to relieve the pain and reduce complications.