输尿管镜气压弹道碎石治疗216例输尿管结石的临床分析.docVIP

输尿管镜气压弹道碎石治疗216例输尿管结石的临床分析 　　作者：罗云伟　,杨曹明　,李坚　,杨立新　　　作者单位：1.云南省红河州开远市人民医院泌尿外科，云南 红河州 661600;2.四川省娥眉山市第二人民医院外科，四川 娥眉山 614200;3.海南医学院附属医院泌尿外科，海南 海口570102 　【摘要】 目的：探讨输尿管镜下气压弹道碎石治疗输尿管结石的疗效。 方法：统计接受输尿管镜下气压弹道碎石术的216例患者的治疗情况，比较输尿管不同部位结石的一次性碎石成功率，分析疗效以及影响疗效的因素，总结手术的不良反应。 结果：一次性碎石成功率为90.28%，输尿管下段和中段结石的碎石成功率高于上段结石，其中下段与上段结石比较差异有统计学意义(P0.05)。影响碎石成功率的主要因素为结石上移，输尿管开口狭窄输尿管镜无法进入输尿管，以及输尿管迂曲或狭窄输尿管镜无法到达结石等。常见并发症有血尿、发热、输尿管黏膜损伤以及输尿管穿孔，最严重者为输尿管穿孔。术后3个月，在获得随访的病例中仅4%～6%的患者有轻微腰腹部隐痛，或患侧肾盂少量积液，且大多很快缓解。 结论：输尿管镜下气压弹道碎石术治疗输尿管结石安全有效，可作为中下段输尿管结石的首选治疗方法。 　　【关键词】 输尿管镜;气压弹道碎石;输尿管结石 　　Pneumatic lithotripsy under ureteroscope for ureteral calculi: 216 cases clinic analysis 　　LUO Yunwei1, YANG Caoming1, LI Jian1, YANG Lixin1, KAN Qiwei2, OU Shanshen3 　　(1.Department of Urinary Surgery, Peoples Hospital in Kaiyuan Municipal Honghezhou 661600; 2.Surgery Department, the 2nd Peoples Hospital in Emeishan Emeishan 614200; 3.Department of Urinary, Affiliated Hospital to Hainan Meclical College Haikou 570102,, China) 　　[ABSTRACT] Objective: To explore the effect of pneumatic lithotripsy under ureteroscope (PLU) on ureteral calculi. Methods: Collected data of 216 cases with ureteral calculi treated by PLU, compared different success rates of lithotripsy at one time in different location, and analyzed the efficacy, influencing factors, and sideeffect. Results: The success rate of lithotripsy at one time was 90.28%, and the rates at lower and middle section of ureter were significantly higher than upper section (P0.05). The main influencing factors were upward displacement of calculi, ureteric orifice stenosis which leads tofailuer of ureteroscope insertion, circuitous ureter or uerter stenosis leading to ureteroscope fail to reach calculi. Complications mainly were hematuria, fever, ureter mucosa injury and ureter perforation. 3 months after treatment, only 4%6% cases remained vague and light pain in lumbar and abdomen, or had little effusion in renal pelvis, and were relieved soone