旁置输尿管导管持续顺行灌流输尿管镜钬激光碎石术——技术改良与临床观察

目的探讨利用改良的旁置输尿管导管持续顺行灌流技术行输尿管镜钬激光碎石治疗输尿管结石的临床效果。方法2008年2月至2009年2月中山大学附属第三医院泌尿外科应用改良的旁置输尿管导管持续顺行灌流输尿管镜钬激光碎石技术治疗30例输尿管结石。改良方法为术中输尿管镜抵达结石下方后，先将一根5F输尿管导管越过结石向上插入10cm，必要时可插入肾盂。保留导管退镜，再从管旁进镜抵达结石。助手经导管持续推注生理盐水，术者在输尿管内形成的向下水流冲刷所致的清晰视野下安全连续碎石。结果本组30例输尿管结石患者单次手术结石粉碎率100％（30／30），平均结石排净时间2d．平均手术时间32min，平均术后住院时间3d。术中及术后无输尿管穿孔、高热、脓肾等并发症。结论旁置输尿管导管持续顺行灌流输尿管镜钬激光碎石术可在清晰视野下连续碎石，结石不易上移。碎石易冲出，疗效确切，安全、并发症少。

Paracalculous ureteral catheter continuous antegrade perfusion ureteroscopic lithotripsy: technological im improvement and clinical observation

Objective To identify the clinical efficacy of modified paracalculous ureteral catheter continuous antegrade perfusion ureteroscopic lithotripsy in treating ureteral stones. Methods From Feb. 2008 to Feb. 2009, 30 patients with ureteral stones underwent modified paracalculous ureteral catheter continuous antegrade perfusion ureteroscopic lithotripsy. During the procedures, when ureteroscope reached the inferior part of the stone, firstly, a 5F ureteral catheter was inserted and crossed by the stone and 10 cm upwards, it can be inserted into the renal pelvis if necessary. Then set the catheter and retracted the scope. Inserted the scope again by the catheter and reached the stone. An assistant injected normal saline through the catheter continuously, the operator can then get a clear vision by the flow flushing downwards and perform lithotripsy in a persistent way. Results All the 30 patients got a pulverization rate of 100%, the mean time of calculus clearance was 2 days, average operative time was 32 minutes, hospital stay was 3 days. No complications such as ureter perforation, fever or renal abscess occurred. Conclusions Paracalculous ureteral catheter continuous antegrade perfusion ureteroscopic lithotripsy can be performed persistently under clear vision, and the calculus can not be moved upwards, and easily to be flushed out. It is a safe procedure with high efficacy and fewer complications.