输尿管管路封堵器在防止输尿管中上段结石上移应用的体会

The Application of Ureteral Occlusion Devive in Preventing Moving up of Middle and Upper Ureteral Calculi Ureteral

目的:探讨输尿管管路封堵器在防止输尿管中上段结石上移应用的临床疗效。方法:2011年12月-2012年12月,对62例单侧输尿管中上段结石患者于输尿管镜工作通道内安置英诺伟TMIVX-SC10输尿管管路封堵器,完全超越结石后,操作体外手柄使叶片折叠防止结石上移,而后使用钬激光或者弹道碎石,在碎石完成后使用封堵器叶片折叠将结石碎片拖出输尿管腔道。无输尿管狭窄患者术后留置D-J管4周,有输尿管狭窄患者留置8周。结果:5例输尿管上段结石在安置输尿管管路封堵器时结石上移至患侧肾中盏,予以留置D-J管,术后体外震波碎石,效果满意。余患者输尿管结石均封堵满意,术中无患者出现输尿管穿孔或输尿管黏膜撕脱。术后无患者出现高热、菌血症、肾功能衰竭。术后拔D-J管前腹部平片,除5例结石上移入肾中盏的患者结石体外碎石后尚未排空外,余57例无明显结石残留,效果显著。结论:输尿管管路封堵器能显著减少输尿管中上段结石碎石术中结石上移,提高结石清除率,减少二次手术操作或后续治疗,其操作简单,值得临床应用推广。

Objective：To explore the clinical application of ureteral occlusion devive in prevention of moving up of middle of upper ureteral calculi ureteral. Method：From December 2011 to December 2012 62 cases of unilateral middle and upper ureteral calculi with ureteroscopic working channel was arranged in the Yingnuowei TMIVX-SC10 ureteral occlusion devive,completely beyond calculus after operation in vitro,handle to blade folding to prevent movement of calculus, and then using the holmium：YAG laser lithotripsy or ballistic lithotripsy,after the completion of the blade in the rubble stone fragments from ureter folded cavity. D-J tube indwelling ureter stenosis patients without stricture of ureter catheter 4 weeks,patients with stricture of ureter catheter for eight weeks.Result：5 cases of upper ureteral calculi ureteral stones in the placement of pipeline occluder when moved to the ipsilateral renal calyx with D-J indwelling tube,carried out the extracorporeal shock wave lithotripsy postoperative,the effect was satisfaction.Residual ureteral calculi patients were occluded satisfaction,there were no patients with ureteral perforation or ureteral mucosa avulsion.There were no postoperative patients with high fever,bacteremia,renal failure.After D-J tube removal of abdominal plain film,except for 5 cases of calculus into a calculus patients with extracorporeal lithotripsy kidney in the light of not emptying,more than 57 cases of no residual stones.Conclusion：Ureteral occlusion devive can significantly reduce the ureteral calculi ureteral calculi lithotripsy up,improve the stone clearance rate,reduce the two operation or follow-up treatment,the operation is simple,is worthy of clinical application.