输尿管镜下弹道-超声碎石清石系统治疗嵌顿性输尿管结石

目的：评价经尿道输尿管镜下EMS第三代弹道-超声碎石清石系统治疗嵌顿性输尿管结石的临床疗效。方法：回顾性分析2008年10月～2011年4月，经尿道输尿管镜下弹道-超声碎石清石系统治疗16例嵌顿性输尿管结石的临床资料。结果：16例中输尿管上段结石3例，输尿管中、下段结石13例，大小为0．7cm×0．5cm～4．0cm×2．0cm。16例均为嵌顿性结石，镜下可见结石表面伪膜包裹及输尿管炎性息肉形成。B超和CT均呈现不同程度的肾盂、输尿管扩张，其中中度肾积水3例、重度肾积水13例。EMS第三代碎石清石系统采用超声-弹道-超声或弹道-超声联合模式均获得成功，碎石时间20～180min，无输尿管穿孔、黏膜撕脱、严重出血等并发症。术后住院2～8天，平均4．6天。术后1～3个月B超及KUB检查，结石排净，积水消失或明显减轻。结论：采用EMS第三代弹道超声联合模式治疗复杂、嵌顿性输尿管结石，安全可靠，成功率高。

Treatment of Impacted Ureteral Calculus by Ureteroscope Combined Pneumatic and Ultrasonic Lithotripsy

Objective：To evaluate the clinical efficiency of using the third generation Swiss LithoClast Master in treating impacted ureteral calculus by ureteroscope. Methods：From October 2008 to April 2011, 16 patients with complex impacted ureteral calculus were treated by ureteroscope combined pneumatic and ultrasound lithotripsy. Their clinical data were reviewed retrospectively. Results：Three patients had stones in the upper ureter, 13 in the middle and the lower ureter. The stones were 0. 7 cm×0. 5 cm 4.0 cm×2.0 cm. Impacted ureteral caleuius encap- sulated by granulation tissue were observed under ureteroscope in all patients. B ultrasonograph and CT showed that 3 patients had moderate hydronephrosis, the others with severe hydronephrosis. All calculi were successfully fragmented and removed, the calculi clearance time was 20-180 min. No severe complications such as massive haemorrhage,ureteral perforation, conglutinant stenosis happened. The hospital stay in this series was 2-8 days. Follow-up was achieved in 16 patients for 1-3 months with significant relief of hydronephrosis,no recurrence was found. Conclusions：Therapeutic alliance by ureteroseope combined pneumatic and ultrasound lithotripsy is an effective and safe therapy. It is useful for those patients with impacted ureteral calculus especially.