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。
Objective To investigate the main causes and strategies for the difficulties in ureteroscopic lithotripsy. Methods From 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. Results In 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. Conclusions Holmium Laser lithotripsy and pneumatic lithotripsy under a rigid ureteroscope are safe and effective in treating ureteral calculi.
出处
《中国微创外科杂志》
CSCD
2007年第11期1103-1105,共3页
Chinese Journal of Minimally Invasive Surgery
作者简介
通讯作者
