摘要
目的通过分析输尿管镜治疗输尿管上段结石的失败原因,提高对输尿管上段结石治疗的效果和成功率。方法我院自2003年5月至2007年6月,共经输尿管镜治疗输尿管上段结石347例,其中碎石失败83例。本组病例年龄23～65岁,平均46岁;男性49例,女性34例。66例患者在术前30d内有过肾绞痛病史。术前曾行体外冲击波碎石治疗失败者14例。术前均行静脉肾盂造影检查,结石直径0.6～1.6cm,平均1.0cm。所有病例使用STORZ产8F输尿管镜。结果1例因结石粉碎不完全,双J管放置未达肾盂,引起梗阻感染,5d后急诊开放手术治愈。3例因结石远端息肉,输尿管镜不能到达结石或术中息肉出血视野不清而中转开放手术取石。63例因结石大部或全部返入肾盂,追加体外冲击波碎石。15例因输尿管狭窄经扩张后或扭曲仍不能到达结石,其中10例中转开放手术取石,5例改行经皮肾镜取石术。1例因术中输尿管穿孔而中转开放。结论经输尿管镜治疗输尿管上段结石失败的原因较多,但通过相应的技术改进和病例选择,可以得到满意的疗效。
Objective By analysis the failure of ureteroscopic lithotripsy for proximal ureteral calculi to improve the efficiency of treatment of the proximal ureteral calculi.Methods 347 patients who underwent semirigid ureteroscopy and holmium： yttrium-aluminum garnet （Ho-YAG） laser for proximal ureteral calculi at the East Hospital between May 2003 and June 2007 were enrolled. Failure outcome was defined as the patient needed open operation, following ESWL and not being stone-free on radiography one month after treatment. A total of 83 patients were failed in this study. Results A total of 83 patients were failure in this study. They are because of DJ disposition （1, 1.2%）, polypus （3, 3.6%）, regurgitation （63, 75.9% ）, ureter narrow or distorted（15, 18.1%） and injury（1, 1.2%）. Before 2005 there are 46 failure cases of totally 128 （36%）, and 37 failure cases of 219 total （17%） after 2005. Conclusion There are varied causes concerning to the failure of ureteroscopic lithotripsy. Most of them can be prevented or the risk be reduced. So after improvement of the details, the method of ureteroscopic lithotripsy for proximal ureteral calculi would be reliable.
出处
《中华腔镜泌尿外科杂志（电子版）》
2010年第2期24-26,共3页
Chinese Journal of Endourology(Electronic Edition)
