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目的:通过回顾性研究探讨输尿管镜下气压弹道碎石术治疗输尿管结石失败原因。方法:对14例应用输尿管镜下气压弹道碎石术治疗输尿管结石失败的病例进行分析。结果:5例患者术中结石移入肾盂,均留置双J管后行体外冲击波碎石(ESWL)治疗;4例输尿管扭曲或狭窄致进镜困难,无法窥见结石,其中2例转开放手术,2例置双J管后ESWL治疗;2例因出血视野不清导致结石残留;1例因输尿管开口异常,置镜失败而中转开放手术;2例因术中输尿管穿孔或黏膜撕脱而转开放手术。结论:结石上移肾盂、输尿管扭曲、输尿管狭窄、输尿管开口异常、术中出血、术中输尿管穿孔黏膜撕脱是输尿管镜下气压弹道碎石失败的常见原因,术中操作者的熟练操作、冲洗速度的调整、术前合适病例的选择是手术成功的关键。
Objective: To retrospectively study the causes of ureteral calculi failure under ureteroscopic pneumatic lithotripsy. Methods: Fourteen patients who underwent ureteroscopic pneumatic lithotripsy for failure of ureteral calculi were analyzed. Results: Five patients had intraoperative stones which were transferred into the renal pelvis. All patients underwent bilateral J-tube embolization with extracorporeal shock wave lithotripsy (ESWL). Four cases of ureteral distortions or stenosis were difficult to get into the mirror. Two cases were treated with ESWL followed by double J tube. Two cases had residual stones due to unclear hemorrhage. One case had open urethral opening due to abnormal ureteral opening and failed to mount the mirror. Two cases were switched to open operation due to ureteral perforation or mucosal avulsion . Conclusions: Ureteroscopic ureteral lithotripsy, ureteral distortions, ureteral strictures, abnormal ureteral openings, intraoperative bleeding and intraoperative ureteral perforation of the ureter are common causes of the failure of ureteroscopic pneumatic lithotripsy. Operators skilled operation and irrigation The speed of adjustment, the appropriate preoperative choice of cases is the key to the success of the operation.