46例输尿管软镜联合钬激光碎石治疗上尿路结石失败原因分析

目的 分析输尿管软镜钬激光碎石术治疗上尿路结石手术失败的原因.方法 回顾本院2014年10月至2016年3月施行的472例软尿管软镜钬激光碎石术治疗上尿路结石病例,筛选46例手术失败病例,记录手术失败的原因,并进行分析.结果 手术失败的原因包括输尿管狭窄或扭曲因素19例(41.3％);肾盂输尿管与肾下盏漏斗部夹角过小11例(23.9％);未找到肾盏憩室结石开口4例(8.7％);肾内感染8例(17.4％);设备有关因素2例(4.3％);操作因素至输尿管损伤2例(4.3％).结论 术前留置1～2周双J管,充分抗感染治疗,常规行肾脏CT及IVU检查,术中留置安全导丝,操作轻柔,必要时经皮肾镜取石术是输尿管软镜钬激光碎石术处理上尿路结石成功的关键.

Causes of flexible ureterorenoscopy with holmium laser lithotripsy failure in 46 patients with upper urinary tract calculus

Objective To analysis reasons of failure in the treatment of flexible ureterorenoscopy with holmium laser lithotripsy.Methods From October 2014 to March 2016,472 patients with upper urinary tract calculus were treated by flexible ureterorenoscopy with holmium laser lithotripsy,46 cases of surgery procedures failed were recorded and analyzed.Results The causes of failure included stricture or tortuous ureter,the infundibulopelvic angle was smaller than 30°,the diverticular neck was not found,with infection of pelvis,equipments damaged and ureteral injury.Conclusions Placed Double -J stent 1 ～2 weeks before operation,antibiotic therapy in patients with urinary tract infection,CT and IVU should performed in all patients,indwelling gnide wire during operation,light and soft performanee,percutaneous nephrolithotomy are needed.All these are key points in flexible ureterorenoscopy with holnium laser lithotripsy.