输尿管镜碎石失败原因分析与处理.docVIP

输尿管镜碎石失败原因分析与处理 　　[摘要] 目的：分析输尿管镜下碎石术失败的常见原因及处理。方法：对27例应用输尿管镜下气压弹道碎石或钬激光碎石术治疗输尿管结石失败的病例进行分析。结果：输尿管管腔炎性息肉形成和狭窄，无法窥见结石7例，输尿管严重迂曲，进镜困难4例，输尿管损伤出血，视野不清5例，均改开放手术切开取石治愈。结石上移进入肾盂肾盏11例，其中，3例行经皮肾镜取石（PCNL）治疗治愈，8例留置双J管后经体外冲击波碎石（ESWL）治愈。结论：熟练的技术操作及严格掌握手术适应证是减少输尿管镜技术失败的关键，配合其他腔内碎石技术，可提高取石成功率。 　　[关键词] 输尿管结石；输尿管镜；碎石术；分析 　　[中图分类号] R693+.4 [文献标识码] B [文章编号] 1674-4721（2012）01（a）-185-02 　　 　　Cause analysis and handling of ureteroscopic lithotripsy failure 　　WEI Qianghua 　　Department of Urology, Guidong Peoples Hospital, Guangxi Zhuang Autonomous Region, Wuzhou 543001, China 　　[Abstract] Objective: To analyze the causes and handling of ureteroscopic lithotripsy failure. Methods: Twenty-seven cases of failed ureteroscopic pneumatic lithotripsy or holmium laser lithotripsy for ureteral stones were analyzed. Results: Ureteral lumen inflammatory polyps formation and stenosis without glimpse of the stone occurred in 7 cases and difficulty of entry of ureteroscope caused by severe tortuous ureter was observed in 4 cases. Poor visibility caused by ureteral injury bleeding occurred in 5 cases, all of which were cured after changing to open surgery. Stones moved into the renal pelvis in 11 cases, of which 3 cases were cured by PCNL and 8 cases were cured by ESWL after placing double-J tube. Conclusion: Skilled operations and strict control of surgical indications is the key to reduce failure of ureteroscopy. The concurrent employment of other lithotripsy techniques can improve the success rate of stone removal. 　　[Key words] Ureteral calculi; Ureteroscopy; Lithotripsy; Analysis 　　 　　目前输尿管镜碎石术普遍开展，操作技术不断提高，其有效性和安全性得到公认，但仍有不少失败情况。本院于2004 年6 月～2011年6 月应用输尿管镜气压弹道碎石术或钬激光碎石术治疗输尿管结石293例，就其中27例失败的原因及处理分析如下： 　　1 资料与方法 　　1.1 一般资料 　　本组输尿管结石患者293例，上段结石41例，中段结石117例，下段结石135例。其中，失败27例（9.2%），男19例，女8例；年龄最大76岁，最小23岁，平均45岁。输尿管上段结石14例，中段8例，下段5例。右侧16例，左侧11例。结石最大1.9 cm×1.3 cm，最小0.7 cm×0.6 cm。以反复肾绞痛，肉眼血尿或肾积水入院。术前均行B超、泌尿系平片、静脉肾盂造影或CT等明确诊断。 　　1.2 手术方法 　　在连续硬膜外麻醉下，取膀胱截石位，应用F8/9.8 wolf 硬性输尿管镜，在电视系统监视下将硬性输尿管