上段输尿管结石的现代微创手术治疗.docVIP

上段输尿管结石的现代微创手术治疗 作者：韩邦 【关键词】 输尿管结石 　　The miniinvasive therapy of upper ureteral caculi 　　Han Bangmin, Xia Shujie, Lu Jun, Fan Jie, Sun Xiaowen, Wen Wei, Zhang Jie 　　(Department of Urology, Shanghai No.1 Hospital, Shanghai 200080, China) 　　ABSTRACT: Objective To investigate the treatment of upper ureteral calculi with miniinvasive surgery. Methods The information of 78 cases of upper ureteral calculi were analyzed, which were treated by ureteroscopic pneumatic lithotripsy and Ho: YAG laser lithotripsy, minipercutaneous nephrolithotomy (mPCNL), laparoscopic ureterolithotomy and open surgery. Results 18 of 24 cases of ureteroscopic pneumatic lithotripsy obtained satisfactory results, while 4 cases needed ESWL after surgery, 1 stopped operation because of bleeding, 1 changed to open surgery because of partial rupture of the ureteral. All of 16 cases of Ho: YAG lithotripsy were successful. In all of ureteroscopic lithotripsy, 2 developed ureter perforation, 5 failed to reach the stones. 27 cases of mPCNL were successful and no severe complications occurred. 3 laparoscopic operation took out the stones suceessfully, no leakage of urine occurred. Conclusion Ureteroscopic pneumatic lithotripsy is effective to remove upper ureteral calculi and Ho: YAG laser lithotripsy is more effective. mPCNL is safe and effective to remove upper ureteral calculi especially the big and tough stones, or those near the pelvic. For those who failed with other miniinvasive surgery, laparoscopic ureterolithotomy is a very good choice. KEY WORDS: ureteral calculi; surgery; ureteroscopic lithotripsy; minipercutaneous nephrolithotomy; laparoscopic ureterolithotomy 　　摘要：目的　 评价各种微创手术方法治疗上段输尿管结石的价值。方法 对我院收治的78例上段输尿管结石患者的治疗方法进行回顾性分析。其中经输尿管镜下气压弹道碎石24例，输尿管镜钬激光碎石16例，微创经皮肾输尿管镜取石(mPCNL)27例，后腹腔镜取石3例，开放手术8例。结果　输尿管镜气压弹道碎石18例碎石成功，4例因较大残石行ESWL，1例因黏膜出血视野模糊终止手术，1例输尿管部分断裂改开放手术；钬激光组16例均碎石成功；逆行输尿管镜共有2例输尿管穿孔，均成功放置DJ管，2例因输尿管过度迂曲成盲端，3例因结石以下输尿管僵硬狭窄无法进镜改开放手术；mPCNL组27例全部取石成功，无严重并发症；后腹腔镜组3