合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石疗效观察

目的探讨合用阿托品输尿管逆行造影联合静脉肾盂造影(IVU)定位行体外冲击波碎石(ESWL)治疗输尿管阴性结石的临床效果。方法对138例患者经B超、IVU、CT检查确诊输尿管阴性结石。采用IVU联合应用阿托品针、碘海醇针合剂经输尿管导管持续微泵泵入,行逆行造影(RGU)辅助,经X线定位后,明确结石的部位及大小后行ESWL治疗。留置输尿管导管综合排石治疗3～5天,观察临床碎石效果。结果本组138例患者经1次ESWL治疗后2～4周,121例(87.8%)完全排净;第2次ESWL治疗结石排净10例(7.2%);第3次ESWL治疗结石排净2例(1.4%);2例(1.4%)形成"石街",需行输尿管镜取石;无效3例(2.2%),行开放手术取石,证实结石有炎性肉芽包裹。结论合用阿托品输尿管逆行造影联合IVU定位行ESWL治疗输尿管阴性结石临床疗效确切,术后留置输尿管导管逆行灌注冲洗利于排石。

Clinical Effects of EWSL Treatment on Urinary Negative Calculi by Atropine Retrograde Urography Combined with Intravenous Pyelography Location

Objective To observe the clinical effects of extracorporeal shock wave lithotripsy(EWSL) treatment on urinary negative calculi by atropine retrograde urography combined with intravenous pyelography(IVU) location.Methods A total of 138 cases were diagnosed as urinary negative calculi by B-ultrasound,IVU and CT.Combined IVU with atropine needles,all the cases were continuous pumped iohexol needle mixture through the ureteral catheter micro-pump.Retrograde urography(RGU) was used to assist clearly the stones X-ray location and size before ESWL treatment.Then the cases retained the ureteral catheter and consolidated treatment of the row of stone 3-5 days to observe the clinical effects.Results Among the 138 cases,expulsion of stone was in 121 cases(87.8%) after the first time ESWL treatment with 2-4 weeks,in 10 cases(7.2%) by the second time ESWL treatment;in 2 patients(1.4%) by the third time ESWL treatment.Two cases(1.4%) formed a "stone street" and needed to line transurethral ureteroscopic lithotripsy(URL),and 3 cases(2.2%) who were confirmed to be stones wrapped by the inflammatory granulation package,were ineffective and needed to open surgery,Conclusion EWSL treatment on urinary negative calculi by atropine retrograde urography combined with intravenous pyelography location has curative effect.Retrograde perfusion washing is beneficial for expulsion of stone after ESWL.