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目的:探讨采用输尿管镜钬激光微创治疗体外冲击波碎石(ESWL)失败的输尿管结石的临床特点及方法。方法:回顾分析我院2010年3月-2013年10月采用输尿管镜钬激光碎石术治疗ESWL失败的32例输尿管结石患者的临床资料。其中3例合并结石远端输尿管狭窄,25例合并息肉包裹,5例ESWL术后石街形成。32例皆合并轻一中度肾积水。结果:本组32例,27例(84.4%)单次手术碎石成功,2例(6.2%)结石向上移位至肾盂术后再行ESWL治疗,3例(9.4%)改开放手术治疗。手术时间最短20min,最长130min,平均42min。结论:ESWL治疗失败的输尿管结石多属复杂性结石;初始的ESWL治疗使进一步腔镜处理较为困难;采用输尿管镜钬激光微创治疗安全、有效,具有治疗周期短、并发症少的优点;部分病例需改行开放手术治疗。
Objective: To investigate the clinical features and methods of ureteroscopic ureteroscopic ureteroscopic minimally invasive ureteral calculi for the treatment of ESWL failure. Methods: The clinical data of 32 patients with ureteral calculi who failed ESWL by ureteroscopic holmium laser lithotripsy in our hospital from March 2010 to October 2013 were retrospectively analyzed. Among them, 3 cases had distal ureteral stricture of stones, 25 cases were complicated with polyps, and 5 cases of ESWL stone street formation. 32 cases were combined mild to moderate hydronephrosis. Results: In this group of 32 cases, 27 cases (84.4%) were successful in single operation grafting. Two cases (6.2%) of stones were shifted upward to pyeloplasty followed by ESWL treatment and 3 cases (9.4%) changed to open operation. The shortest operative time 20min, the longest 130min, average 42min. Conclusions: Ureteral calculi with unsuccessful ESWL treatment is complicated by complicated stones. Initial ESWL treatment makes further endoscopic treatment more difficult. Ureteroscopic holmium laser minimally invasive treatment is safe and effective with the advantages of short treatment period and few complications. Cases need to switch to open surgery.