输尿管结石ESWL原位治疗失败的原因与对策(附16例分析)

目的探讨ESWL原位治疗输尿管结石失败的原因与处理措施。方法与结果分析16例输尿管结石ESWL原位治疗失败的临床资料。16例中,8例改输尿管切开取石术,6例改输尿管镜下钬激光碎石术,2例改钬激光术后因少量碎石滑至肾脏又补充行ESWL治疗,均治愈。术中证实输尿管炎性狭窄6例,息肉2例,肉芽组织包裹2例。结论ESWL治疗输尿管结石疗效可靠,但要正确掌握好适应证。若病程长,肾积水严重,患肾功能差,或结石结构致密,且面积大,则不宜选择ESWL术。ESWL治疗失败后,输尿管上段结石首选输尿管切开取石术,输尿管下段结石首选输尿管镜下钬激光碎石术。

Causes of ESWL failure for ureteral calculi and treatment (Analysis of 16 cases)

Objective:To explore the causes of ESWL failure for ureteral calculi and the methods of dealing with.Methods and Results:Analysis was made on 16 cases of ureteral calculi failure with ESWL. In the 16 cases, ureterolithotomy was made in 8 cases, ureterocystoscope with holmium was made in 6 cases,Another ESWL was made in 2 cases because of the failures of ureterocystoscope with holmium and then some smashed calculus were slided to the kiney. Ureterolithotomy or ureterocystoscope with holmium revealed that adhesive ureterostenosis in 6,inflammatory ureteral polyp in 4,encapsulation of the calculi by granulation tissue in 2.Conclusions:ESWL is a good way to treat ureteral calculi for its dependability,but it only can be used in indication.If the calculi is incarcerated at the same spot for a long time, the kidney was filled with water , the sick kidney's function was poor or the stone's dimension was big and the structure was tight,ESWL should be contraindicated. Ureterolithotomy is the best way for upper segment ureteral calculi and ureterocystoscope with holmium is the best way for middle or lower segment ureteral calculi when ESWL fails.