逆行输尿管镜下气压弹道碎石术治疗输尿管大结石

目的 探讨逆行输尿管镜下气压弹道碎石术治疗输尿管大结石的安全性与有效性.方法 自2000年1月至2005年10月采用逆行输尿管镜下气压弹道碎石术治疗输尿管大结石68例,其中11例此前经过体外震波碎石未成功.男42例,女26例,年龄21～69岁,平均44岁.输尿管上段结石59例,中段7例,下段2例.结石直径2.0～4.4 cm,平均2.4cm.结果 68例输尿管结石一次彻底清除率89.7%(61例).2例结石上移至肾盂未完成手术;5例术后出现输尿管结石粉末残留,其中2例术后4周行静脉肾盂造影复查发现结石已排空,2例经过再次逆行输尿管镜下气压弹道碎石术彻底清除,1例经过输尿管切开取石清除.68例均未出现输尿管穿孔、输尿管狭窄等并发症.结论 逆行输尿管镜下气压弹道碎石术治疗输尿管结石安全、清除彻底、并发症少,可作为治疗输尿管大结石的首选.

Pneumatic Lithotripsy through Retrograde Ureteroscope for Treatment of Large Ureteral Calculi

Objective To investigate the safety and efficacy of pneumatic lithotripsy through retrograde ureteroscope as the treatment for large ureteral stones. Methods From January 2000 to October 2005, we performed pneumatic lithotripsy through retrograde ureteroscope in 68 patients (42 men, 26 women, age range 21~69 years, mean age 44 years) with large ureteral stones more than 2 cm in size. Of the 68 stones, 59 were located in the lower ureter, 7 were in the middle ureter, and 2 were located in the lower ureter. The mean stone diameter was 2.4 cm (range 2.0~4.4 cm), Of the 68 patients, 11 had stones that could not be effectively fragmented by shock wave lithotripsy (ESWL) previously. Results Of the 68 stones, 61 (89.7%) were removed completely by a single pneumatic lithotripsy through retrograde ureteroscope. The operation failed in 2 cases due to shift of the stone to the renal pelvis. 5 cases had residual fragments in the ureter, 2 could not be found on IVU 4 weeks after operation, 2 were removed completely by second pneumatic lithotripsy through retrograde ureteroscope, 1 was cleared completely by open surgery. None of 68 patients had complications of perforation or ureteral stricture. Conclusion Pneumatic lithotripsy through retrograde ureteroscope is a safe and effective technique with less complications and complete clearance of the calculi. It can be a first-line therapy for large ureteral stones.