[1]张树栋,肖春雷,王国良*,等.硬性输尿管镜碎石困难的原因分析及对策[J].中国微创外科杂志,2007,07(11):1103-1105.
　Zhang Shudong,Xiao Chunlei,Wang Guoliang,et al.Causes and Strategies for the Difficulties in Ureteroscopic Lithotripsy[J].Chinese Journal of Minimally Invasive Surgery,2007,07(11):1103-1105.
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硬性输尿管镜碎石困难的原因分析及对策()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
07
期数:
2007年11期
页码:
1103-1105
栏目:
出版日期:
2007-11-20

文章信息/Info

Title:
Causes and Strategies for the Difficulties in Ureteroscopic Lithotripsy
作者:
张树栋; 肖春雷; 王国良*; 马潞林; 黄毅; 侯小飞; 卢剑; 赵磊; 田晓军
北京大学第三医院泌尿外科，北京100083
Author(s):
Zhang Shudong;  Xiao Chunlei;  Wang Guoliang;  et al.
Department of Urology, Peking University Third Hospital, Beijing 100083, China
关键词:
输尿管镜;  输尿管结石
Keywords:
Ureteroscopy;  Ureteral calculi
分类号:
R693+.4
文献标志码:
A
摘要:
目的探讨硬性输尿管镜下碎石术中常见困难的原因与相应处理。方法回顾分析19例2004年3月～2006年12月应用F8/9.8硬性输尿管镜钬激光或气压弹道碎石术治疗输尿管结石术中操作困难的临床资料。输尿管入口狭窄造成硬镜置入困难3例，结石梗阻严重合并输尿管炎性息肉包裹导致碎石困难6例，因输尿管各段狭窄而输尿管镜上行困难6例，输尿管扭曲成角导致输尿管镜上行困难4例。结果15例经调整手术方法、改变灌注泵压力、狭窄段内切开等方法碎石成功；2例输尿管全程狭窄，留置双J管后行体外冲击波碎石治疗；2例碎石失败，行经皮肾镜碎石后取净结石。4例出现并发症：2例输尿管穿孔，2例输尿管黏膜撕脱。其中1例中转开放手术,余3例保守治疗后痊愈。结论硬性输尿管镜钬激光或气压弹道碎石术治疗输尿管结石是安全有效的，熟悉输尿管的解剖特点，熟练掌握手术操作技巧，可以提高碎石成功率。
Abstract:
ObjectiveTo investigate the main causes and strategies for the difficulties in ureteroscopic lithotripsy.MethodsFrom March 2004 to December 2006, 19 cases of ureteral calculi, who experienced difficulties during holmium laser lithotripsy or pneumatic lithotripsy under a rigid ureteroscope, were analyzed retrospectively. Among the cases, 3 had difficulties in ureteroscope placement due to the narrow ureteral ingress, 6 owing to calculus obstruction complicated with ureteral inflammatory polypi, 4 resulted from twisted ureter, and 6 because of stenosis of the ureter.ResultsIn 15 of the patients, the operation was successfully performed by changing surgical approach, controlling the hydraulic irrigation, and incising the stenotic segments, etc. Two patients, who had stenotic ureter, received ESWL with doubleJ catheter dwelling. Lithotripsy failed in 2 cases, and PCNL was used to remove the calculi. The postoperative complications occurred in 4 cases, including 2 with mucosal laceration and 2 ureteral perforations. One of the 4 cases was transferred to an open surgery, and the other 3 were cured by conservative treatments. ConclusionsHolmium Laser lithotripsy and pneumatic lithotripsy under a rigid ureteroscope are safe and effective in treating ureteral calculi.

参考文献/References:

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备注/Memo

备注/Memo:
*通讯作者
更新日期/Last Update: 2013-12-09