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输尿管病变影响腔内碎石疗效的原因分析 |
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王谷丰 刘士贵
摘要 目的：分析各种输尿管病变对腔内碎石疗效的影响。方法：采用经尿道输尿管镜气压弹道碎石术治疗输尿管结石126例，术前影像学及术中内窥镜观察输尿管病变情况。结果：输尿管上段结石原位碎石治愈率为81%，输尿管中下段为96%。结论：并发输尿管肉芽组织或息肉包裹、近端输尿管梗阻扩张迂曲和折叠成角、输尿管狭窄是影响腔内碎石疗效的主要原因，对此可采用不同方法对症处理，提高治愈率。
关键词 输尿管镜碎石术 输尿管病变 输尿管结石
Endoureteral lithotripsy: influence factors originated from ureteral diseases
WANG Gu-feng
（Department of Urology, Liuzhou Hospital of Traditional Chinese Medicine,Guanxi,545001）
LIU Shi-gui
（Department of Urology, Liuzhou Steel-Iron Group Hospital, Liuzhou,Guanxi）
Abstract Purpose: To understand the influence of ureteral diseases to the therapeutical effects of endoureteral lithotripsy. Methods: 126 cases of the ureteral calculi were treated by means of transurethral ureteroscopy ballast lithotripay. Ureteral diseases were observed through endoscopy during operation and image. Results: The cure rate of stones in the upper segment was 81%, and that of middle and distal stones was 96%. Conclusions: The ureteral diseases, such as ureter expansion, tortuousness and fold that due to obstruction, encapsulation of the calculi by granulation tissue or inflammatory ureteral polypi and stricture, etc, are the main causes. Different methods should be applied to increase the cure rate.
Key words Ureteroscopy lithtripay Ureteral disease Ureteral stone
随着经验的积累及腔内碎石设备的改进，腔内碎石术的技术方法与疗效出现了很大改变。1997年1月～1998年10月，我们采用输尿管镜碎石术治疗输尿管结石126例，现报告如下，并观察分析输尿管病变对其疗效的影响。
1 资料与方法
1.1 一般资料
本组126例，男93例，女33例，年龄14～60岁。结石位于输尿管上段54例，中下段72例；左侧50例，右侧73例，双侧3例，其中单侧多发性结石10例，结石最多5枚。体外冲击波碎石术后形成输尿管石街7例。结石大小(0.3 cm×0.5 cm)～(1.5 cm×3.0 cm)。
1.2 治疗方法
患者取截石位，作双管硬膜外麻醉。采用Wofl F8.0～9.8输尿管肾镜，经尿道进入膀胱，插入输尿管导管作为引导，借助MCC腔内窥镜灌注泵扩张输尿管，采用直入法进入输尿管，观察结石及周围情况。启动APL气压弹道碎石机，经输尿管肾镜工作通道插入1.6 mm碎石杆接触结石并将其击碎。结石碎块用取石钳取出至膀胱，待术后排尿时自行排出。进镜至肾盂后改换工作导丝推入F5双猪尾导管于输尿管内做支架引流。如结石大碎块被冲入肾内，可加用ESWL治疗。
2 结果
输尿管上段结石原位碎石成功率为81%(44/54)，6例加[1] [2] 下一页
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