输尿管镜气压弹道碎石术的疗效分析：附380例报告

目的探讨输尿管镜气压弹道碎石取石术治疗输尿管结石的疗效。方法回顾性分析我院自2006年7月至2011年1月应用输尿管镜气压弹道碎石取石术治疗输尿管结石380例的临床资料。结果手术时间24．5±14．6min,气压弹道平均碎石时间15min。365例输尿管镜下气压弹道碎石取石成功,占96．1％（365/380）,随访1～3个月,结石排净率为97．8％（357/365）,13例患者因输尿管下段狭窄或输尿管扭曲无法进入输尿管镜。56例合并息肉或肉芽包裹的结石患者均用气压弹道成功处理。术后发热25例次,5例术后出现不明原因低血压。术后长期随访未见明显并发症。结论输尿管镜气压弹道碎石术是治疗输尿管中下段结石的一种安全、高效、微创手术,对体外冲击波碎石失败和合并输尿管息肉患者为首选。熟练、耐心、轻柔、准确的输尿管镜操作有助于减少并发症的发生。     

经皮肾或经尿道输尿管镜治疗输尿管上段结石

目的探讨经皮肾微造瘘与经尿道途径输尿管硬镜气压弹道碎石治疗输尿管上段结石的疗效。方法经尿道途径（18例）：硬膜外麻醉下逆行插入输尿管硬镜至结石下方进行气压弹道碎石,并逐一钳出结石碎屑。经皮肾途径（23例）：全麻,俯卧位,B超辅助经皮肾穿刺微造瘘,插入输尿管硬镜,经肾盏、肾盂、抵达输尿管结石上方,气压弹道碎石,石屑自造瘘管冲出。结果15例经尿道途径一次取石成功;1例因镜体穿破结石下缘输尿管壁而即刻改行开放取石、修补输尿管穿孔成功;另2例术中结石漂移回肾盂而改行经皮肾镜取石成功。经皮肾途径23例均一次性取石成功。41例随访2～24个月,平均13个月,KUB显示结石无残留或复发。结论经皮肾微造瘘治疗输尿管上段结石,取石成功率高,并发症相对较少。     

输尿管镜术治疗35例输尿管结石并绞痛

目的 探讨输尿管镜术在治疗输尿管结石并绞痛的临床疗效。方法 分析35例输尿管结石并绞痛患者应用输尿管镜术治疗的效果。结果 除1例输尿管上段结石行气压弹道碎石后，部分碎石入肾盂外，其余均一次碎石、取石成功，一次碎石成功率97．1％（34／35），无并发症发生。结论 采用输尿管镜术治疗输尿管结石并绞痛，疗效可靠、安全、损伤小，是治疗输尿管结石并绞痛的首选方法，值得临床推广。     

输尿管镜气压弹道碎石术治疗输尿管结石412例报告

目的：探讨输尿管镜（URS）气压弹道碎石术治疗输尿管结石的临床疗效。方法：采用URS取石或配合气压弹道碎石术治疗输尿管结石患者412例。结果：一次性碎石取石成功率为88．3％，其中输尿管上段结石为56．3％（18／32），输尿管中段结石为87．9％（80／91），输尿管下段结石为97．1％（266／274），并发症主要为术后发热（13例），肾绞痛（9例），及血尿等。结论：URS气压弹道碎石术治疗输尿管结石安全有效，损伤小，是治疗输尿管中下段结石的好方法。     

输尿管镜钬激光碎石术治疗妊娠合并输尿管上段结石64例报告

目的：探讨妊娠合并输尿管上段结百的诊断和处理方法。方法：采用输尿管镜联合钬激光碎石术治疗妊娠合并输尿管上段结石患者64例。结果：64例患者中．53例一次性碎石取石f净（82．8％）,7例结石部分碎片上移人肾盂（10．9％）,4例因输尿管扭曲、狭窄等原因上镜失败（3．3％）．其中3例置入进口F1.8双J管成功．1例置管失败。1例术后出现先兆流产（1．6％）,经处理后缓解。所有患者术后肾绞痛、发热等症状均缓解消失．未发现流产等特殊并发症．疗效满意。结论：输尿管镜联合钬激光碎石术治疗妊娠合并输尿管上段结石一次性醑石率高,并发症少,对孕妇、胎儿影响较小,方法安全有效。     

输尿管镜用于中下段输尿管结石治疗的临床分析

目的探讨输尿管半硬镜联合钬激光碎石、套石蓝取石在输尿管中下段结石治疗中的安全、有效性。方法回顾分析2004～2011年间800例输尿管中下段结石患者的临床资料并比较各类输尿管镜联合不同碎石、取石技术的治疗效果,其中气压弹道碎石340例,钬激光碎石460例。结果输尿管半硬镜下钬激光碎石联合套石蓝取石术放镜成功率100%、平均手术时间（34.2±10.3）min、结石移位率1.3%、管壁损伤率1.1%、中转开放术率0.4%、术后残石率0.9%,主要技术指标均优于传统输尿管镜气压弹道碎石术。结论输尿管半硬镜联合钬激光碎石、套石蓝取石技术治疗输尿管中下段结石便捷、安全、高效,值得临床推广。     

输尿管镜气压弹道碎石术治疗输尿管结石(附665例报告)

目的探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法采用输尿管镜下气压弹道碎石术治疗输尿管结石665例。结果一次性碎石成功率97.3%（647/665）。术中并发症发生率0.2%（1/665）。结论输尿管镜下气压弹道碎石术较安全，疗效确切，损伤小，可作为治疗输尿管中下段结石的首选方法。     

膨宫机在输尿管镜手术处理输尿管结石合并息肉的应用价值

目的 评价膨宫机在输尿管镜碎石取石术处理输尿管结石合并息肉中的应用价值,探讨输尿管结石合并息肉的处理技巧.方法 回顾我科行输尿管镜碎石取石术术中发现结石合并息肉的52例患者临床资料,其中输尿管上段结石18例,中下段结石34例,25例采用膨宫机持续灌注生理盐水扩张法行弹道碎石取石术(膨宫机辅助组),27例采用挂高水袋配合人工注水扩张法行弹道碎石取石术(传统碎石组);两组术中均常规留置双J管;比较两组的总手术时间、碎石时间、结石清除率、术中及术后并发症情况.结果 52例患者均全部成功碎石,无一例中转开放手术,两组均无输尿管断裂、撕脱并发症发生,传统碎石组1例术中发生输尿管穿孔.膨宫机辅助组与传统碎石组的总手术时间分别为31.2±5.1 VS 37.0±6.2 min (t=-3.68,P=0.0006<0.05),碎石时间分别为6.5±1.4 VS 9.4±1.5 min(t=-7.19,p=0.0000<0.05);传统碎石组有1例上段结石术中上移至肾盂,术后采用体外冲击波碎石清除结石.两组患者术后均得到3个月~1年随访,超声复查均未见结石残留及输尿管狭窄并发症发生.结论 术中应用膨宫机持续灌注生理盐水扩张输尿管结合一定的弹道碎石技巧能使术野保持清晰,可明显减少总手术时间、碎石及清石时间,疗效确切,在输尿管镜处理输尿管结石合并息肉中有重要的临床应用价值.     

输尿管镜下气压弹道碎石术治疗60例输尿管上段结石

目的探讨输尿管镜下气压弹道碎石术治疗输尿管上段结石的临床疗效。方法置入输尿管镜，经膀胱逆行置入F5输尿管导管，缓慢将输尿管镜进入输尿管后在直视下观察结石，置入气压弹道碎石机进行碎石，取石结束后常规留置F6双J管。结果手术时间30～58min，（45．8±10．1）min；术中出血量7—18ml，（10．9±3．1）ml。8例由于术中结石冲人肾盂，术后改用体外冲击波碎石治疗，一次手术成功率86．7％（52／60）。2例分别于术后7、9d发生脓毒血症，经保守治疗痊愈。43例随访1—6个月，平均3个月，无肾积水及输尿管狭窄发生，术后1个月内结石均排净。结论输尿管镜下气压弹道碎石术治疗输尿管上段较小的结石疗效满意。     

输尿管镜气压弹道碎石术治疗输尿管结石（附126例报告）

目的探讨输尿管镜气压弹道碎石术（URL）治疗输尿管结石的疗效。方法采用输尿管镜（URS）下气压弹道碎石技术治疗输尿管结石126例。结果一次性碎石成功率91．3％。结论输尿管镜气压弹道碎石术治疗输尿管结石安全、有效、微创，是治疗输尿管中、下段结石的好方法。     

Treatment outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy in pregnant women with obstructive ureteral calculi

The purpose of the study is to evaluate the outcomes of semirigid ureterorenoscopy and intracorporeal lithotripsy as a definitive treatment in pregnant women with obstructive ureteral calculi. A retrospective analysis was performed of 16 pregnant patients referred to gynecology department with ureteral obstruction from 2007 to 2009. The mean age was 25 years, and mean gestation period was 30 weeks. Of the 16 patients; 50% had fever, 100% flank pain, 56% dysuria, 25% gross hematuria, 50% positive urine culture, and 75% pyuria and microscopic hematuria. Abdominal ultrasonography was the principle diagnostic test used. The mean stone size was 9.45 mm. Eleven of the 16 patients, 54% had stones located in the distal ureter and 46% proximal ureter. The stones were fragmented using a swiss pneumatic lithoclast through 9.5 F semirigid ureteroscope by 0.035 mm safety guidewire with the patient under general anesthesia. Eleven patients had obstruction due to the ureteral calculi. Eight of 11 patients had complete fragmentation of the calculi by ureteroscopy as a primary treatment. Push-back was performed in the other three patients. By applying Dj catheter, and performing eswl after giving birth, the patient became stone-free. Dj catheter was applied peroperative to all 16 patients. No complications were recorded, and all patients completed the full term of pregnancy. The results of our study have shown that semirigid ureteroscopy to diagnose ureteral calculi and treat them with intracorporeal pneumatic lithotripsy and ureteral stent insertion, as indicated, is the most efficient and definitive treatment modality in pregnant women.     

Benefits of ureteroscopic pneumatic lithotripsy for the treatment of impacted ureteral stones.

PURPOSE: Although new forms of lithotripsy, such as new-generation shockwave and laser lithotripsies, have recently been developed, the optimal treatment for impacted ureteral stones (IUS) remains controversial. We investigated, retrospectively, the outcome of IUS treated with ureteroscopic pneumatic lithotripsy. PATIENTS AND METHODS: Twenty-two IUS cases were treated using ureteroscopic pneumatic lithotripsy. Of 22 stones, 8 (36%) were treated by ureteroscopic pneumatic lithotripsy as initial treatment and 14 (64%) with pneumatic lithotripsy as an auxiliary treatment after SWL. The stone sizes ranged from 7 to 16 mm with 14 located in the proximal, 3 in the middle, and 5 in the distal ureter. RESULTS: Twenty stones (91%) were effectively fragmented by ureteroscopic pneumatic lithotripsy and eliminated within 1 month after treatment. One stone could not be observed with the ureteroscope secondary to the kinking and stricture of the ureter under the stone, and the stone moved into the kidney during the procedure. The stone was subsequently treated successfully with SWL. One other stone was first fragmented into two pieces; and one big piece, which migrated into the kidney, was treated successfully with SWL. Complications such as bleeding, ureteral injury, and perforation did not occur. Although a few small fragments migrated into the kidney during the procedure in three cases, the overall stone-free rate at 1 month after a one-session treatment with pneumatic lithotripsy was 91%. CONCLUSION: Impacted ureteral stones can be treated effectively with ureteroscopic pneumatic lithotripsy in both the short and the long term.     

Treatment of urinary calculi with ureteroscopy and Swiss lithoclast pneumatic lithotripter: report of 150 cases

PURPOSE: To present our clinic experience with the Swiss Lithoclast pneumatic lithotripter in the endoscopic management of urinary calculi. PATIENTS AND METHODS: From August 1994 to December 1997, 145 patients with ureteral calculi and 5 patients with urethral calculi were treated with the Swiss Lithoclast. RESULTS: In the ureteral stone group, ureteroscopic addressing of the stones was successful in 133 patients. In 27 patients, the stones were partially fragmented and remained in situ or were pushed back to the calices. They were subsequently treated successfully with SWL. Stones were fragmented in a single session in 101 cases. Complications associated with the procedure included five perforations and four urinary tract infections. All of the five urethral stone patients were treated successfully with pneumatic lithotripsy. The overall successful fragmentation rate thus was 70.7% (106 of 150) and 88.7% (133 of 150) in combination with adjuvant SWL. CONCLUSIONS: We have found Swiss Lithoclast pneumatic lithotripsy to be a safe, effective, and economical treatment method for urinary calculi. If combined with other modalities such as SWL, this treatment will be even more effective.     

Ureteroscopic treatment of ureteral lithiasis with pneumatic lithotripsy: analysis of 287 procedures in a public hospital

Ureteroscopes and different lithotripsy methods have greatly improved the urologists ability to treat ureteral stones, regardless of their location in the ureter. We retrospectively reviewed our experience with ureteroscopic pneumatic lithotriptor in 287 patients with ureteral calculi. Ureteroscopic stone treatment was performed between October 1999 and May 2004. Of 221 patients with distal ureteral calculi, 209 (group 1), and 58 of 66 patients with upper ureteral calculi (group 2) were treated successfully by ureteroscopy alone. In group 1, seven migrated stones (to the upper urinary tract) were successfully treated by ESWL later. There were five-treatment failures due to ureteral perforation which consequently required open ureterolithotomy. In group 2, there were five patients with migrated stones; two of them were sent to a percutaneous nephrolithotomy center because of previously unsuccessful ESWL attempts. Three of these with migrated stones were treated by ESWL later. In three patients, we switched to open ureterolithotomy because of ureteral rupture that required surgical repair. Ureteroscopic pneumatic lithotripsy is a safe and effective treatment modality for ureteral calculi.     

输尿管结石的现代治疗(附569例报告)

目的 :报告应用现代微创技术治疗输尿管结石的经验。方法 :2 0 0 1年 1月～ 2 0 0 2年 6月间 ,应用体外冲击波碎石 (ESWL)、输尿管镜腔内碎石 [包括气压弹道腔内碎石 (PL)和钬激光腔内碎石 (HLL) ]、腹腔镜输尿管切开取石 (LUL)和开放手术 (OS)治疗各种类型输尿管结石 5 6 9例 ,并随访其疗效及并发症的发生率。结果 :ESWL 36 8例 ,结石粉碎率为 96 .2 % ,3个月后结石清除率为 87.6 % ;HLL 110例 ,10 6例结石一次性粉碎(96 .4 % ) ;PL 4例结石均一次粉碎排出 ;2 1例行LUL患者 ,手术均获成功 ;6 6例行OS的患者均为结石体积较大(>1.8cm)或双侧结石伴有肾功能不全者。结论 :ESWL和HLL可作为输尿管结石的首选治疗方法。LUL和OS可作为首选疗法失败后的补救方法或用于少数结石体积较大的病例     

Management of the impacted ureteral calculus

The management of 42 impacted ureteral calculi is reviewed. Impacted stones were defined by the inability to pass a guide wire or catheter on initial attempts. Stones were impacted in the upper ureter in 10 patients, mid ureter in 11 and lower ureter in 21. Upper ureteral stones were treated in 8 patients by extracorporeal shock wave lithotripsy after disimpaction by laser or other techniques. Mid ureteral stones were treated by laser alone in 7 patients and by extracorporeal shock wave lithotripsy after disimpaction in 4. Lower stones were treated by laser in 17 patients and ultrasound in 2. Complications included 3 major and 5 minor perforations, and 4 false passages. Treatment was successful without an open operation in 40 of 42 patients (95%). Our current approach to impacted ureteral calculi involves passing a rigid ureteroscope to the stone, with disimpaction performed by laser fragmentation or other dislodgement maneuvers. Proximal stones or large fragments then are treated by extracorporeal shock wave lithotripsy. Mid ureteral stones are treated similarly, unless they are so fragile that in situ fragmentation may be completed easily. Lower ureteral stones are fragmented in situ, with hard fragments extracted by basket. Alternative treatments for impacted calculi at all levels include unstented in situ extracorporeal shock wave lithotripsy, antegrade ureteroscopy and, finally, an operation.     

Extracorporeal shock-wave versus pneumatic ureteroscopic lithotripsy in treatment of lower ureteral calculi

Aim: To compare the efficacy and complications of extracorporeal shock-wave lithotripsy (SWL) and pneumatic ureteroscopic lithotripsy (URS) in the treatment of lower ureteral calculi. Methods: From August 1997 to June 1999, 210 patients with calculi in the distal third of the ureter were treated with SWL and the other 180 with URS. The stones were fragmented with either HB-ESWL-V lithotripter or JML-93 pneumatic lithotripter through Wolf 7.5～9.0 Fr ureteroscope. The outcome was assessed in terms of stone clearance rate, re-treatment rate and complication incidence. Results: The stone clearance rate was 78.1% with SWL and 93.3 % with URS (P<0.05). SWL had a re-treatment rate of 11.9 %, vs 2.2 % in the URS group (P<.05). URS caused ureteral perforation in 3.3% of patients, while it was 0 with SWL (P<0.05). The differences in the incidence of other complications such as infection and stricture between the two groups were insignificant. Conclusion: Though the selection of these two options depends on equip     

Ureteroscopic management of ureteral calculi in children

PURPOSE: To evaluate the efficacy and safety of rigid ureteroscopy for the treatment ureteral calculi in children. PATIENTS AND METHODS: Between January 2002 and January 2006, 16 boys and 25 girls with an average age of 9.5 years (range 3-15 years) were treated with a 95F rigid ureteroscope for stones 4 to 10 mm (mean 5.6 mm) in 46 renoureteral units (RUUs), and the results were evaluated. The stones were located in the upper ureter in 4 RUUs, the middle ureter in 15, and the lower ureter in 27. Dilatation of a tight ureteral orifice was necessary in 17 cases (36.9%). RESULTS: On examination during ureteroscopy, all calculi were well fragmented, and in 33 patients (94%), stone fragments were removed directly. Stones were fragmented with pneumatic lithotripsy in 23 RUUs and removed by forceps with or without fragmentation in the remaining 23. Whereas the treatment was successful in 36 children (87.8%), it was unsuccessful in 5 (12.2%) secondary to bleeding and mucosal injury in 3 children (7%; 1 middle- and 2 upper-ureteral stones) and severe ureteral stenosis with kinking in 2 (4.8%; 1 middle- and 1 upper-ureteral stone) children. In two other cases, although the fragments in the upper portion of the ureter could be reached with the ureteroscope, the stones migrated into the renal collecting system during pneumatic lithotripsy and were treated successfully with subsequent SWL (4.8%). At the end of the procedure, a 4.8F Double-J stent was left in place in 9 cases. There were no serious complications, and the children were not specifically evaluated for postoperative vesicoureteral reflux. Follow-up ranged from 1 to 36 months with an average duration of 22.4 months. CONCLUSION: With the aid of the experience gained in the adult population and careful instrumentation, we believe that, in skilled hands, rigid ureteroscopy can be applied in a safe and efficient manner for stones located in different portions of the pediatric ureter.     

输尿管镜下气压弹道碎石治疗输尿管结石

目的 探讨输尿管镜下气压弹道碎石治疗输尿管结石的治疗效果. 方法 我院2002年8月～2006年4月采用Wolf F8/9.8硬性输尿管镜联合瑞士EMS气压弹道碎石机碎石治疗输尿管结石158例163侧.采用椎管内麻醉,生理盐水作为冲洗液,输尿管镜进入输尿管,到达结石处后,气压弹道击碎并取出结石,并上行观察输尿管全长,术后留置双J管引流.结果手术时间15～90 min,平均40 min.碎石成功率96.9%（158/163）,其中输尿管上段结石碎石成功率86.6%（13/15）,中段结石碎石成功率96.9%（46/49）,下段结石碎石成功率100%（99/99）;2例输尿管上段结石移位至肾盂内,留置双J管后行体外冲击波碎石,其余3例为结石被击碎后,残余小结石进入肾盂,留置双J管后行药物排石或体外冲击波碎石.术中出现输尿管穿孔3例（1.8%）,留置双J管引流后治愈;无输尿管粘膜撕脱、断裂、周围血管脏器损伤等严重并发症,无中转开放手术.125例随访1～38个月,平均15个月,B超或KUB检查,无结石复发. 结论输尿管镜下气压弹道碎石具有碎石成功率高,创伤小,手术时间较短等优点,是治疗输尿管结石的一种安全、有效的方法.     

输尿管结石的输尿管镜气压弹道碎石术治疗

目的探讨提高治疗输尿管结石疗效的方法。方法对146例(153侧)输尿管结石行输尿管镜气压弹道碎石术治疗。结果输尿管上段结石32侧气压弹道碎石成功率为53.1%;输尿管中段结石15侧气压弹道碎石成功率为66.7%;输尿管下段结石106侧气压弹道碎石成功率为95.3%。治疗输尿管结石总成功率为83.7%(128/153),手术并发症为2.6%(4/153)。结论经尿道输尿管镜气压弹道碎石术是治疗输尿管结石的一种安全、有效的方法。