输尿管镜气压弹道碎石术治疗输尿管结石临床应用.doc

输尿管镜气压弹道碎石术治疗输尿管结石临床应用 　　【摘要】 目的：探讨输尿管镜气压弹道碎石术治疗输尿管结石的手术技巧及临床疗效。方法：回顾分析笔者所在医院2011年1月-2014年 　　6月采用输尿管镜联合气压弹道碎石术治疗364例输尿管结石患者的临床资料，观察治疗效果及相关并发症。结果：本组364例患者，手术时间15～80 min，平均35 min，术中出血量5～30 ml，平均10 ml，住院时间2～7 d，平均3.5 d，一次性碎石成功率为94.5%，上段结石碎石成功率为90.2%，中段为93.7%，下段为98.4%，并发症发生率为2.5%。结论：输尿管镜联合气压弹道碎石治疗输尿管结石疗效确切，合理选择病例、提高手术操作技巧、实施临床路径可有效提高碎石成功率，缩短住院时间，减少并发症的发生，值得临床推广。 　　【关键词】 输尿管镜； 气压弹道； 输尿管结石 　　中图分类号 R693.4 文献标识码 B 文章编号 1674-6805（2015）11-0014-03 　　【Abstract】 Objective：To investigate the surgical technique and clinical efficacy of ureteroscopy pneumatic lithotripsy in the treatment of ureteral calculus.Method：The clinical data of 364 patients with ureteral calculus who treated with ureteroscopy combined pneumatic ballistic lithotripsy in our hospital from January 2011 to June 2014 were retrospectively analyzed，and the treatment effect and related complications were also observed.Result：In 364 patients of this group，the operative time was from 15-80 min，the average was 35 min；the intraoperative blood loss was 5-30 ml，the average was 10 ml；the hospitalization time was from 2-7 days，the average was 3.5 days，the one-time success rate of crushing calculi was 94.5%，success rate of crushing calculi in the upside segment was 90.2%，in the middle segment was 93.7%，in the downside segment was 98.4%，the incidence rate of related complication was 2.5%.Conclusion：The curative effect of ureteroscopy combined with pneumatic lithotripsy in the treatment of ureteral calculus is effective.Through reasonable chosen of cases and improvement on operative techniques，the implementation of clinical pathways can effectively improve the success rate of crushing calculi，shorten the length of hospital stay and reduce complications，is worth clinical promotion. 　　【Key words】 Ureteroscopy； Pneumatic； Ureteral calculus 　　临床上治疗输尿管结石的方法多种多样，包括体外冲击波碎石（ESWL）、输尿管镜碎石（URL）、经皮肾镜碎石（PCNL）、后腹腔镜切开取石及开放手术等，由于开放性手术治疗对患者的创伤较大，且围手术期存在较多的风险，术后恢复缓慢[1]，因此输尿管镜气压弹道碎石术作为新型高效的腔内泌尿外科手术近年来广泛运用于泌尿系结石的治疗，特别是对于输尿管中下段结石，输尿管镜碎石取石