体外冲击波术后输尿管石街的输尿管镜处理体会

目的:探讨输尿管镜钬激光碎石取石术处理体外冲击波术后输尿管石街的手术技巧。方法:收治23例肾或输尿管结石体外冲击波术后输尿管石街形成的患者,其中输尿管上段石街9例,中下段石街14例,均行输尿管镜钬激光碎石取石术,术中于输尿管镜直视下经结石周边缝隙逆行置入4F输尿管导管跨过结石,旁置持续注水行钬激光碎石取石,术中均留置双J管,观察手术的效果及并发症。结果:23例患者全部成功碎石,无一例中转为开放手术,术中均无输尿管穿孔、断裂等并发症发生。总手术时间为(38±7)min,碎石时间为(9±3)min,术后腹部平片检查未见结石残留。术后随访3个月～1年,B超复查均未见结石残留及输尿管狭窄等并发症发生。结论:术中应用输尿管导管旁置持续注水能有效防止结石上移并保持术野清晰,结合一定的碎石取石技巧,输尿管镜钬激光碎石取石术处理体外冲击波术后输尿管石街疗效确切,值得临床应用推广。

Clinical experience of ureteroscopic holmium laser lithotripsy in the treatment of ureteral street stone caused by extracorporeal shock wave lithotripsy

To investigate the surgical technique of ureteroscopic holmium laser lithotripsy in the treatment of steinstrasse caused by extracorporeal shock wave lithotripsy （ESWL）. Methods： Twenty-three patients suffered from ureteral steinstrasse caused by ESWL were enrolled, among which upper and middle or inferior urethral steinstrasse were presented in 9 and 14 cases, respectively. All cases received ureteroscopic holmium laser lithotripsy. Double J tube was placed. Surgical effects and complications were observed. Results： All operations were succeeded without requirement of open surgery. No ureter perforation or breakage was reported. Total operation duration was （38 ±7） min, with stone removal of （9 ±3） rain. Stone clearance rate were 100% according to KUB. All patients received 3 months to 1 year follow-up. Thus B-ultrasound showed no residual stones and postop- erative ureteral stricture occurred. Conclusions： Intraoperative paracalculous ureteral catheter and continuous antegrade perfusion can prevent stone migration, maintain clear operation field and favor stone removal. The combination of certain surgical skills of ureteroscopie holmium laser lithotripsy results in good outcome.