输尿管软镜碎石术后输尿管石街形成分析及处理

Treatment of ureteral steinstrasse formation after retrograde intrarenal surgery

目的:探讨输尿管软镜碎石术后石街形成的原因及处理方法。方法:2013年7月~2014年12月采用输尿管软镜碎石术治疗338例,术后复查发现有5例患者出现输尿管石街,其中男4例,女1例,平均年龄51岁。4例为单侧肾结石,1例为双侧肾结石,结石长径1.5~3.5cm,平均2.8cm,平均手术时间85min;石街长3~12cm,予行输尿管镜取石术,3例患者术中发现结石聚集成团块状,需再次用钬激光击碎梗阻结石后用套石篮套出碎石,2例患者结石聚集较疏松,予套石篮使其松动后逐一套出输尿管。结果:5例患者术后结石全部清除,2周后拔除留置的双J管,患者痊愈。结论:结石较大,粉碎不够彻底,肾内血块或渗出物未及时清除及术中输尿管有损伤是术后石街形成的主要因素,术中应注意避免。

Objective:Todiscuss the cause and the treatment of ureteral steinstrasse formation after retrograde intrarenal surgery.Methods:338patients undergoing retrograde intrarenal surgery were retrospectively reviewed,including 5cases of ureteral steinstrasse after retrograde intrarenal surgery.There were 4men and 1woman.The mean age was 51 years.The diameter of stone ranged from 1.5cm to 3.5cm,and 2.8cm averagely.Four patients were diagnosed as unilateralrenal stone and 1as bilateral renal stone.Ureteroscopiclithotripsy was performed on all patients.Three patients were given Holmium laser lithotripsy for the crushing stones gathering into a mass.Stones in the other 2patients were taken out by basket extractor because the gathering stones were loose.The mean operation time was 85 min.Results:The residual ureteral stones were cleared free in 5patients.Double J stents were placed after ureteroscopic lithotripsy and removed 2 weeks later.Conclusions:The cause of ureteral steinstrasse formation after retrograde intrarenal surgery includes the large size of stone,the large size of residual stones,the cruor or effusion not be removed promptly and injuries of ureter during the surgery.