体外冲击波碎石术治疗双J管石垢致拔管困难者的疗效分析

Efficacy of shock wave lithotripsy in treating patients with double J stent extubation difficulties due to the stone scales surface

目的探讨体外冲击波碎石术（ESWL）治疗双J管石垢致拔管困难患者的疗效。方法回顾性分析1999年7月至2013年12月收治的30例因留置双J管形成表面石垢致拔管困难患者的资料。男18例，女12例。年龄24～83岁，平均46岁。留置双J管时间1．5～36．0个月，平均8．3个月。单发结石10例，多发结石20例；左肾结石14例，右肾结石6例，左输尿管结石3例，右输尿管结石7例。影像学特点：输尿管石垢环绕于双J管外周，呈条型管状分布；肾结石围绕双J管管头处20例，表面毛糙10例。结石直径0．7～3．2cm，平均1．8cm。均采用ESWL治疗，冲击次数2000～3300次，平均2800次；治疗电压：4—8kV。结果本组30例，碎石时间40～70min，平均45min。术中及术后无并发症发生。30例术后均立即顺利拔除双J管。拔管后1周随访，结石均排出。结论ESWL治疗结石垢引起的双J管拔管困难是一种简单、方便、有效的方法。

Objective To evaluate clinical efficacy of extracorporeal shock wave lithotripsy （ESWL） for treating patients with double J （DJ） stent extubation difficulties. Methods A retrospective analysis were conducted from July 1999 to December 2013, total 30 cases （ 18 male and 12 female） were accepted the ESWL therapy for treating the DJ extubation difficult due to the stone scales surface. The average age in those patients was 46 years （range 24 to 83 years）. The average duration of DJ stents indwelling was 8.3 months （range 1.5 to 36.0 months）. There were 10 cases with single stone and 20 cases with multiple stones. The distribution of stone location included left kidney in 14 cases, right kidney in 6 cases, left ureter in 3 cases and right ureter in 7 cases. The ureteral stone scales around the DJ stent showed tubular distribution. The distribution of imaging characteristic included kidney stones around the DJ stent joint in 20 cases and surface coarse in 10 cases. The diameter of the stone ranged from 0.7 to 3.2 cm （mean 1.8 cm）. All the 30 cases were treated by ESWL with the 2 000-3 300 times frequency （ mean 2 800 times）. Treatment volt- age was 4-8 KV. Results Gravel time ranged from 40 to 70 min （mean 45 min）. No intraoperative and postoperative complications occurred. Their DJ stents were easily extubated immediately after ESWL. One week after ESWL, all the patients reported the flushing of the stone. Conclusion ESWL is a simple, convenient and efficacy way to solve the DJ stent extubation difficulties due to the scales surface.