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目的分析输尿管镜下汽压弹道碎石治疗输尿管结石失败原因及防治措施。方法分析20例汽压弹道碎石治疗输尿管结石手术失败的临床资料。结果20例失败病例中,有11例手术中结石移位至肾盂无法碎石;4例因输尿管行走迂曲或输尿管及输尿管开口狭窄置镜失败;2例因输尿管局部出血导致视野不清而终止手术;3例因输尿管穿孔改为开放手术。结论输尿管镜治疗输尿管结石疗效可靠,结石移位、输尿管走行迂曲或狭窄、术中视野不清、输尿管穿孔是手术失败的主要原因。合理选择病例;术中操作仔细、谨慎,保持适当的灌注速度和压力,保持视野清晰是手术成功的关键。
Objective To analyze the causes of failure of ureteroscopic lithotripsy under ureteroscope and the preventive measures. Methods The clinical data of 20 cases of failed ureteral calculi treated by vapor pressure lithotripsy were analyzed. Results Of the 20 failed cases, 11 had stones that failed to move to the renal pelvis during operation; 4 had tortuous ureter or failed ureter and ureteric stenoses; 2 failed to clear the view due to ureteral hemorrhage ; 3 cases due to ureter perforation to open surgery. Conclusions Ureteroscopic treatment of ureteral calculi is reliable, the stones are displaced, the ureter goes tortuous or narrow, the intraoperative visual field is unclear, and the ureter perforation is the main reason of the failed operation. Reasonable choice of cases; intraoperative careful and cautious operation, maintaining proper perfusion rate and pressure, to maintain a clear vision is the key to the success of the operation.