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目的:评估经皮顺行输尿管镜碎石术治疗输尿管第二狭窄处较大结石的疗效及安全性。方法:2008年11月~2013年5月采用经皮顺行输尿管镜碎石术治疗输尿管第二狭窄处结石患者17例,其中输尿管单发结石11例,输尿管多发结石6例,结石最下端均位于输尿管第二狭窄处;合并同侧肾结石8例。结石平均直径2.83(1.7~12.8)cm。结果:17例患者中,16例(94.1%)一次清除全部结石;1例(5.9%)清除合并的肾结石,但因上段输尿管过度迂曲无法进镜到输尿管结石部位,改行开放性输尿管切开取石术。16例平均手术时间87(45~165)min,术中无输尿管穿孔及胸腹脏器损伤,术后血红蛋白平均下降2.6(1~5)g/L,无输血患者。术后24小时及1个月复查KUB均未见结石残留。平均随访6.2个月,未见输尿管狭窄发生。结论:对于位于输尿管第二狭窄以上的输尿管大结石患者,顺行输尿管镜碎石术是一种安全有效的治疗方法。
OBJECTIVE: To evaluate the efficacy and safety of transcutaneous ureteroscopic lithotripsy for the treatment of larger stones in the second ureteral stricture. Methods: From November 2008 to May 2013, 17 cases of second ureteral calculi were treated by percutaneous ureteroscopic lithotripsy, including 11 cases with ureteral calculi, 6 cases with multiple ureteral calculi, and the lowest end of calculi Located in the second ureteral stricture; the same ipsilateral kidney stones in 8 cases. The average diameter of stones is 2.83 (1.7 ~ 12.8) cm. Results: Of the 17 patients, 16 cases (94.1%) cleared all the stones at one time. One case (5.9%) cleared the combined kidney stones. However, because the upper ureter was too tortuous to enter the ureteral calculi, the open ureter was switched Stone surgery. The mean operative time was 87 (45-165) min in 16 patients. There was no perforation of the ureter and the injury of the thorax and abdomen in the operation. The average hemoglobin after operation was 2.6 (1-5) g / L, and no transfusion was found. 24 hours after surgery and 1 month review KUB no stone residue. The average follow-up of 6.2 months, no ureteral stricture occurred. Conclusions: Ureteroscopic lithotripsy is a safe and effective treatment for patients with ureteral calculi above the second narrowing of the ureter.