输尿管镜气压弹道碎石术治疗输尿管结石

目的评价输尿管镜气压弹道碎石术（URSL）治疗输尿管结石的临床疗效。方法使用输尿管镜下气压弹道碎石术治疗输尿管结石170例，输尿管上段结石10例，输尿管中段结石42例，输尿管下段结石118例，结石最大直径2．2cm，平均1．0cm，合并患侧肾积水80例，伴肾绞痛77例，平均病史为24周。结果一次性碎石成功率90．5％（154例）；10例输尿管壁残留小结石，术后1个月复查静脉肾盂造影（IVU），残石已排净；2例较大残余结石上移至肾盂行体外冲击波碎石（ESWL），1个月内结石排净；4例改开放手术，2例为结石被息肉严重包裹碎石失败，2例结石远端严重狭窄；均无输尿管穿孔、撕裂、假道、撕脱等并发症；随访9—12个月，肾积水病例积水情况明显改善；伴肾绞痛病例症状消失；未见结石复发病例。结论输尿管镜气压弹道碎石术治疗输尿管结石疗效确切、安全。

Clinical research of ureteral calculi treated with pneumatic lithotripsy through transurethral rigid ureteroscope

Objective To evaluate the clinical efficacy of pneumatic lithotripsy through transurethral rigid ureteroscope for the treatment of ureteral calculi. Methods 170 patients with ureteral calculi underwent pneumatic lithotripsy through ureteroscope.10 patients had calculi in the proximal ureter, 42 patients,in the middle part, 118 patients, in the distal part. The size of stones ranged from 0.6 cm to 2.2 cm in diameter, average was 1.0 cm. There were ipsilateral hydronephrosis in 80 patients, and panyinenal colic in 77 patients. The average period of stones stayed was 24 weeks. Results 154 cases(90.5%) were stone free immediately after the procedures.10 cases had residual fragments on the ureteral wall, which were eliminated and could not be found in IVU one month after the procedures. 2 cases with residual large fragments were shifted to the renal pelvis and treated with ESWL and finally eliminated one month. 2 cases procedure were failed due to polypus packed the stone seriously and converted to open surgery translumbar ureterolithotomy. The procedure failed in 2 cases due to narrow of ureteral distal part which were converted to open surgery translumbar ureterolithotomy. None of 170 cases had complications of ureteral perforation and injury. Accompanying ipsilateral hydronephrosis were decreased. The renal colic of all patients were disappeared. All patients were follow-uped for 9-12 months, no recurrence were observed. Conclusions Pneumatic lithotripsy through rigid transurethral ureteroscope for the treatment of ureteral calculi is effective and safe.