摘要
目的 总结输尿管镜气压弹道碎石术治疗输尿管结石的临床经验。方法 回顾性分析我院1999年12月～2013年7月输尿管镜气压弹道碎石术治疗1180例输尿管结石的临床资料。硬膜外麻醉1100例，静脉复合麻醉72例，尿道黏膜表面麻醉8例。在F4输尿管插管或斑马导丝引导下，采用上挑法、旋转法或直入法等将输尿管镜置人输尿管口，使用1.2mm气压弹道碎石金属探杆，空气压力泵气压2～3kPa，以单脉冲或连续脉冲粉碎结石。结果 置镜失败21例：8例因输尿管口狭窄，13例因输尿管严重扭曲；13例行开放手术或腹腔镜取石，8例行体外震波碎石（ESWL）。41例结石移位至肾盂改行ESWL，2例因并发症（1例输尿管部分断裂，1例输尿管套袖状撕脱）转开放手术，27例碎石失败自行选择其他治疗。碎石成功率92.3％（1089／1180）。输尿管损伤37例：黏膜下假道形成21例，穿孔9例，部分断裂5例，除1例急诊手术修补外均放置支架管治愈；输尿管套袖状撕脱2例，1例长段撕脱急诊手术修补，术后3个月死于其他疾病，1例撕脱1cm，放置支架管3个月后痊愈。术后发热36例，腰痛160例，对症治疗好转。42例有较大碎石残留术后行ESWL。术后1个月结石排净1036例，结石排净率87.8％（1036／1180）；3个月后另有69例结石排净。994例随访3个月，1例死于其他疾病，超声及静脉肾盂造影提示肾盂轻度扩张25例，残余结石11例，其余患者未见异常。结论 输尿管镜气压弹道碎石术结石排净率高，结合ESWL疗效满意。在导丝引导下采用下压上挑法置镜成功率高，F4输尿管导管作为导丝综合效果好，控制手术时间，术后留置双J管有利于减少并发症的发生。
Objective To summarize our clinical experience of the treatment of ureteral calculi with ureteroscopic pneumatic ]ithotripsy. Methods The clinical data of 1180 cases of uteteral calculi treated by ureterocopic pneumatic lithotripsy from December 1999 to July 2013 were analyzed retrospectively. Epidural anesthesia was performed in 1100 cases, intravenous anesthesia in 72 cases, and urethral mucosal surface anesthesia in 8 cases. Under the guide of F4 ureteral catheter or zebra guide wire, we placed ureteroscopy into the ureter using the ＂ pick-up＂ method, ＂ rotation＂ method or ＂ straight＂ method, and crushed the stones using the I. 2 mm metal probe, with the air pressure pump pressure being 2 - 3 kPa and single or continuous pulse. Results Ureteroscope insertion failed in 21 cases because of ureteral stenosis in 8 cases and ureter distortions in 13 cases, and they were treated afterwards by open or laparoscopic surgery（13 cases） and ESWL（8 cases） respectively. Forty-one cases recieved ESWL due to the shift of the stones to the renal pelvis, 2 cases underwent open surgery due to complications （ 1 case of partial rupture of the ureter and 1 case of ureter avulsion） , and 27 cases chose other treatment after operation failure. The successful rate of lithotripsy was 92.3% （1089/1180）. Thirty-seven cases were complicated with ureter injury including perforation （9 cases） , urethral submucosa pseudocanal （21 cases） , and partial fracture （5 cases）. One case was treated by open surgery and the others by placement of double-J. Two cases were complicated with ureter avulsion. One case was treated by open surgery and died of other diseases 3 months later, and the other was cured by the placement of double-J. Thirty-six cases suffered from fever, 160 cases suffered from lumbago and all the symptoms were relieved after respective treatment. Forty-two cases were treated by ESWL due to residual stones. A total of 1036 cases （87.8% , 1036/1180） were stone-free 1 month after the surgery; another sixty-nine cases were stone-free 3 months after operation. A total of 994 cases were followed up for 3 months. One patient died of other disease; ultrasound and intravenous urography showed mild hydronephrosis in 25 cases, residual stones in 11 cases, and the remaining cases recovered well. Conclusions Ureteroseopic pneumatic lithotripsy is an effective procedure for nreteral calculi. The effect is more satisfactory when combined with ESWL. Placing ureteroscopy into the ureter with the method of downward press and pick-up under the guide wire is feasible and effective. The application of F4 ureteral catheter as guide wire obtains good results. Good control of the operative time and postoperative D-J tube replacement could reduce the incidence of complications.
出处
《中国微创外科杂志》
CSCD
2014年第5期426-429,共4页
Chinese Journal of Minimally Invasive Surgery
