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

Contemporary managements of ureteral calculi (Report of 569 cases)

Purpose:To review our experience of four contemporary minimally invasive procedures for managing ureteral calculi in a group of 478 patients.Methods:Between January of 2001 and June of 2002,478 patients were divided into five groups and respectively with extracorporeal shock wave lithotripsy (ESWL), ureteroscopic lithotripsy [including holmium: YAG laser lithotripsy(HLL) and pneumatic lithotripsy(PL)], Laparoscopic ureterolithotomy (LUL) and open surgery(OS).Results:The rate of stone fragmentation for 368 patients under-went ESWL was 87.6%; One hundred and six ( 96.3%) of 110 patients' stones treated with HLL were effectively fragmented in initial treatment; Complete stone fragmentations and eliminations were achieved in all 4 patients using PL; All LUL of 12 patients and OS of 66 patients were also accomplished successfully. The latter included mainly the cases with macro-size stone (> 1.8 cm) and/or renal failure.Conclusions:ESWL and HLL are suggested as the first-line management for ureter calculi; LUL or OS can be a salvage alternative for failed ESWL and HLL.