输尿管镜气压弹道碎石术结石上移原因及处理对策

目的:探讨输尿管结石输尿管镜气压弹道碎石过程中结石上移的原因及防止对策。方法:对接受输尿管镜气压弹道碎石术治疗的178例患者进行回顾性分析。结果:28例输尿管上段结石碎石过程中有4例上移进入肾盂,78例中段结石和72例下段结石无一例进入肾盂,但均有上移。合并息肉甚至被息肉包裹的结石在术中上移的距离明显下降。结论:碎石过程中冲水速度过快、水压过大、碎石探针冲击力、未合并息肉(及是否被息肉包裹)是结石上移的主要原因。减低水的流速、降低水压、碎石前插入输尿管导管越过结石等可有效防止结石上移。

Cause Analyzing and Handling of Calculus Migration in Ureteroscope Pneumatic Lithotripsy

Objective: To evaluate cause analyzing and handling of calculus migration in ureteroscope pneumatic lithotripsy.Methods: We retrospectively reviewed the records of 178 cases of transureteroscopic pneumatic lithotripsy performed at our department for ureteral calculus.Results: Stones went up to pelvis in operation process in 4 cases of 28 patients with upper ureteral calculus,but no of 78 patients with middle ureteral calculus and 72 patients with inferior ureteral calculus was migrated to pelvis.The migrate distance in lithotripsy of calculi with polyps or even encapsulated by polyps would decrease significantly.Conclusions: Fast rushing water speed,high water pressure,needle impact,calculi not encapsulated by polyps are the principal cause of the calculus migrating in lithotripsy,degrading water speed、depressing water pressure、inserting ureteral catheter and overshooting calculus could prevent calculus migration effectively.