输尿管镜气压弹道碎石术失败原因分析

目的:通过回顾性研究探讨输尿管镜下气压弹道碎石术治疗输尿管结石失败原因。方法:对14例应用输尿管镜下气压弹道碎石术治疗输尿管结石失败的病例进行分析。结果:5例患者术中结石移入肾盂,均留置双J管后行体外冲击波碎石(ESWL)治疗;4例输尿管扭曲或狭窄致进镜困难,无法窥见结石,其中2例转开放手术,2例置双J管后ESWL治疗;2例因出血视野不清导致结石残留;1例因输尿管开口异常,置镜失败而中转开放手术;2例因术中输尿管穿孔或黏膜撕脱而转开放手术。结论:结石上移肾盂、输尿管扭曲、输尿管狭窄、输尿管开口异常、术中出血、术中输尿管穿孔黏膜撕脱是输尿管镜下气压弹道碎石失败的常见原因,术中操作者的熟练操作、冲洗速度的调整、术前合适病例的选择是手术成功的关键。

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Abstract:【Objective】To explore the regular reason of the failure in the ureteroscopic operations and suggest the precautionary measures.【Method】The clinical data of 14 cases with operations failed out of 156 cases of ureteroscopic operations were retrospectively analyzed ．【Result】Five cases of patients with stones into the pelvis, were detained later, for ESWL treatment with D-J tube;four cases with ureteral stricture or distorted ,unable to visualise stones,which two cases to open surgery;one case of abnormal openings of ureter,which to open surgery;two cases because of the mucosal perforation or avulsion and to open surgery. 【Conclusion】Stones into renal pelvis,ureter distorted, ureteral stricture, ureter opening abnormal, bleeding, perforation in the mucosa of avulsion is the common causes of failure.In the operation of the skilled operation, washing speed adjustment,the appropriate choice is the key to a successful operation.