60例输尿管膀胱壁内段结石处置及分析

Treatment of ureterovesical junction stones

目的分析探讨输尿管壁内段结石的处理,比较分析体外冲击波碎石和输尿管镜取石3种处理方案。方法对输尿管膀胱壁内段结石,根据患者自主要求分组,要求体外冲击波碎石(1组),要求体外冲击波碎石同时口服盐酸坦索罗辛缓释胶囊(2组),要求输尿管镜碎石取石(3组),进行观察分析比较。结果 1组14例患者,体外冲击波碎石治疗后,结石排尽9例,5例患者结石未排出,治疗观察期间无明显并发症;2组18例患者,体外冲击波碎石治疗后同时口服盐酸坦索罗辛缓释胶囊0.2mg/qn,结石排尽16例,2例患者结石未排出,治疗观察期间无明显并发症;3组28例患者行输尿管镜取石,25例结石术中清除,3例患者输尿管镜未进入输尿管,术后泌尿系感染2例,术后出血7例,本组病例中无结石上移,输尿管穿孔,严重全身感染患者。结论体外冲击波碎石治疗及输尿管镜取石均为处理输尿管末端结石的重要外科手段,体外冲击波碎石治疗作为非侵入体内的处理手段,可避免麻醉及手术的风险,同时口服盐酸坦索罗辛缓释胶囊可提高结石清;输尿管镜取石,可及时解除梗阻因素,明确输尿管末端情况,输尿管镜取石由于结石位于输尿管末端,有引起术后出血,输尿管镜不能进入输尿管等术后并发症风险。

Objective To investigate the treatment of ureterovesical junction stones, and comparatively analyze different treatments, i.e. extracorporeal shock wave lithotripsy （ESWL） and ureteroscopic lithotripsy. Methods Patients with ureterovesical junction stones were divided into ESWL group （group 1）, ESWL ＋ oral tamsulosin hydrochloride sustained-release capsule group （group 2） and ureteroscopic lithotripsy group （group 3） according to their own treatment requirements, and observed and comparatively analyzed. Results Among 14 patients in group 1, 9 patients had thorough calculus removal after ESWL, whereas 5 patients did not have complete calculus removal. No significant complication was observed during treatment. Among 18 patients in group 2 who were given 0.2mg/qn oral tamsulosin hydrochloride sustained-release capsules after ESWL, 16 patients had thorough calculus removal, whereas 2 patients did not have complete calculus removal. No significant complication occurred during treatment. 28 patients in group 3 underwent ureteroscopic lithotripsy, of whom 25 had calculus removal, while 3 had failed of ureteroscopic insertion. Postoperative urinary tract infection occurred in 2 patients, and postoperative bleeding was found in 7 patients. No upward calculus migration, ureteral perforation or severe systemic infection was observed in the patients studied herein. Conclusion Both ESWL and ureteroscopic lithotripsy are important surgical treatments for distal ureteral stones. As a non-invasive treatment, ESWL can avoid the risks of anesthesia and surgery, and in combination with oral administration of tamsulosin sustained-release capsules, the stone clearance rate can be improved. Ureteroscopic lithotripsy can timely relieve obstruction, and clearly display the distal ureteral status. However, as the stones are located in the distal end of ureter, ureteroscopic lithotripsy has the risks of postoperative complications such as bleeding and failed ureteroseopic insertion.