输尿管硬镜碎石中的困难与方法探讨

Difficulties and Methods Investigation of Holmium Laser Lithotripsy Under the Ureteroscope

目的:分析在使用输尿管镜下钬激光治疗输尿管结石的过程中遇到的各种困难和失败的原因,积极寻找处理方法。方法:总结2003年5月-2012年7月期间使用输尿管硬镜行钬激光碎石,其中108例发生不同程度的进镜和碎石困难临床资料。结果:108例输尿管结石患者中,35例是由于输尿管开口异常(包括输尿管开口和壁内段狭窄32例、开口囊肿3例),23例结石被息肉包裹,27例输尿管上段结石合并结石下方输尿管扭曲狭窄。3例输尿管镜被输尿管钳包,进退镜困难。20例输尿管上段结石漂移至肾盂。结论:输尿管镜下钬激光碎石治疗输尿管结石中有进镜受阻,碎石困难,结石容易返回到肾盂内等困难,正确的处理,可以提高手术的有效性和安全性,降低手术的风险。

Objective： To analyze various reason of difficulties and failure encountered ＇in the treatment of ureteral calculus by using holmium laser lithotripsy under the ureteroscope, so as to find solutions.Method： The clinical data of 108 patients who underwent holmium laser lithotripsy under the ureteroscope for ureteral calculus were analyzed and had difficulties in ureteroscope-inserting and stone-breaking different degrees from May 2003 to July 2012.Result： Among the 108 cases, 35 cases were caused by abnormal opening of the ureters （ including 33 cases of narrow ureteral orifice and 2 cases of orifice cyst ） .Urethral calculus was wrapped by polypus in 23 cases, 27 cases were resulted from upper-ureteral calculus accompanied and the ureters below were tortuous or narrow; ureteroscope were wrapped by ureters in 3 cases, which led to difficulties in inserting and withdrawing the ureteroscope; the stone moved from upper ureters up to renal pelvis happened in 20 cases.Conclusion： In the treatment of ureteral calculus by using holmium laser lithotripsy under the ureteroscope, some difficulties occurre, such as ureteroscope-inserting block, difficulty on stone-breaking, stone returning to renal pelvis easily and so on.Correct approaches could improve the effectivity and security of the surgery, and decrease the risk of it.