输尿管硬镜气压弹道碎石术治疗无肾积水或轻度肾积水肾结石

目的：探讨输尿管镜气压弹道碎石术治疗无肾积水或轻度肾积水肾结石的疗效及适应证。方法：采用输尿管硬镜气压弹道碎石术治疗肾结石14例。其中肾盂结石9例，上盏结石4例．中盏结石1例。并与同期21例经体外震波碎石(ESWL)和5例微创经皮肾穿刺气压弹道碎石术(MPCNL)治疗的病例进行比较。结果：经输尿管镜气压弹道碎石治疗一次性碎石率86％(12／14)．术后1个月结石清除率100％(14／14)，手术时间30～82min．平均50min；术后住院2～4d，平均2．8d。无输尿管穿孔、脓肾等并发症。同期采用ESWL治疗21例．平均治疗2～6次。一次性碎石率19％(4／21)。术后1个月结石清除率38％(8／21)。5例采用MPCNL碎石术，碎石成功率40％(2／5)。结论：输尿管硬镜治疗无积水、轻度积水的肾结石安全有效。与ESWL和MPCNL相比。碎石确切，治疗时间短，对肾功能无损伤．并发症少．但须掌握其适应证。

Transureteroscopic pneumatic lithotripsy in the treatment of renal calculi

Objective: To explore the clinical effect and indication of transureteroscopic pneumatic lithotripsy in the treatment of renal calculi. Method: Fourteen cases of renal calculi treated with ureteroscopic pneumatic lithotripsy from May 2002 to November 2004 were studied retrospectively. Of them, 9 had pyeldithiasis, 4 had superior caliceal stone, 1 had middle caliceal stone. Simultaneously, 21 cases were treated with extracorporeal shock-wave lithotripsy(ESWL), 5 cases were treated with micro-invasive percutaneous nephrostomic lithotripsy(MPCNL). Results: Under transureteroscopic pneumatic lithotripsy, the successful rate of stone fragmentation after single session was 86%(12/14), the clearance rate of stone after one month was 100%(14/14), the mean operation duration was 50 minutes (30~82minutes), the mean duration of post-operation in hospital was 2.8days(2~4days), no ureteral perforations or pyonephrosis occurred. Under ESWL, the successful rate of stone fragmentation after single session was 19%(4/21), the clearance rate after one month was 38%(8/21). Under MPCNL, the successful rate of stone fragmentation after single session was 40%(2/5). Conclusion: Being mastered its indication, treatment of renal calculi with non-hydronephrosis or mild hydronephrosis by transureteroscopic pneumatic lithotripsy is safe, effective and less invasive.