ESWL治疗输尿管结石失败原因分析

采用ＤｏｒｎｉｅｒＨＭ３型碎石机治疗输尿管结石２６００例，其中５８例未获成功，改行输尿管切开取石术及输尿管镜取石术。术中发现结石已粉碎或部分粉碎，但未能全部排出。输尿管明显病变５２例，其中粘连狭窄１５例，管壁增厚１２例，息肉１１例，肉芽组织包裹９例，结石嵌顿４例，输尿管扭曲畸形１例。５８例患者经ＥＳＷＬ治疗共９８次，平均为１６９次。在输尿管结石行ＥＳＷＬ之前应慎重考虑，如结石在输尿管同一部位停留时间过久、结石过大、肾功能较差时，都不宜贸然行ＥＳＷＬ治疗。输尿管结石在行ＥＳＷＬ治疗１～２次无效时，应及时改用其它方法。

Causes of failure of ESWL for ureteral calculi

cases of urreteral calculi were treated by ESWL with HM 3 lithotripter. The procedure failed in 58 cases and the following were observed on ureterolithotomy or ESWL:Most of the calculi were fragmented or partly fragmented but residual calculi being present. Ureteropathy were observed in 52 cases, adhesive ureterostenosis in 15, mutual thickening and sclerosis of ureteral wall in 12, inflammatory ureteral poly pin 11, encapsulation of the calculi by granulation tissue in 9, incarcerated calculi in 4 and twisting deformity of the ureter in 1. The above mentioned conditions handicapped the elimination of the calculi. ESWL is the treatment of choice for ureteral calculi but the following conditions might be contraindications for ESWL:(1) The calculus being incarcerated at the same spot for a long period. (2)Poor kidney function on the effected side.(3)The stone being too big.