经腹腔镜或输尿管镜治疗体外冲击波碎石失败的上尿路结石(附45例报告)

目的 评价腹腔镜及输尿管镜治疗体外冲击波碎石（ESWL)失败的上尿路结石的疗效。方法 对ESWL治疗失败的输尿管中、上段结石行腹腔镜经腹膜后输尿管切开取石术，对ESWL治疗失败的输尿管下段结石及输尿管石街行输尿管镜气压弹道碎石术。结果 26例输尿管中上段结石行腹腔镜经腹膜后输尿管切开取石术，24例取石成功，2例结石滑入肾盂，腹腔镜与输尿管镜组合应用取出结石；8例输尿管下段结石经输尿管镜气压弹道碎石成功；11例输尿管石街行输尿管镜气压弹道碎石，9例1周内碎石屑大部分排出，2例石街内仍有较大碎石，放置输尿管内支架管后继续行ESWL排出结石。结论 腹腔镜及输尿管镜治疗ESWL失败的上尿路结石创伤小，效果理想，可作为首选。

Treatment of upper urinary calculi after failed ESWL by laparoscopy or ureteroscopy

Objective: To evaluate the clinical results of laparoscopy and ureteroscopy for upper urinary calculi after failed (Extracorporeal Shockwave lithotripsy, ESWL). Methods: Middle and upper ureteral calculi after failed ESWL were treated by retroperitoneal laparoscopic ureterolithotomy. Transureteroscopic pneumatic lithotripsy was performed on lower ureteral calculi and ureteral stone street after unsuccessful ESWL. Results: Success achieved in 24 cases with retroperitoneal laparoscopic ureterolithotomy; two cases with stones slipping into the pelvis were transferred by ureteroscopy. 8 cases of lower ureteral stone by ureteroscopic pneumatic lithotripsy also gained success. Among the 11 cases of ureteral stone street, 9 cases were treated sullessfully. Conclusions: Laparoscopy and ureteroscopy were effective with little trauma. The procedure should be considered as the first choice for upper urinary calculi after failed ESWL.