ESWL补救治疗输尿管镜气压弹道碎石失败输尿管结石23例临床观察.docVIP

ESWL补救治疗输尿管镜气压弹道碎石失败输尿管结石23例临床观察[摘要] 目的 探讨输尿管镜下气压弹道碎石治疗输尿管结石失败后体外冲击波碎石术（ESWL）补救的治疗效果。方法 回顾性分析2008年3~12月输尿管结石患者23例，均为输尿管镜下气压弹道碎石术失败，采用ESWL补救治疗，观察碎石的效果。结果 23例经体外冲击波碎石治疗，碎石效果良好，碎石逐步随尿液排出体外，1~2周后在膀胱镜下拔除双J管，复查KUB示无残余结石。结论 输尿管镜下气压弹道碎石对于输尿管下段结石效果较好，上段结石容易因结石上漂造成气压弹道碎石失败，体外冲击波碎石提供了补救治疗的方法，碎石效果好。 [关键词] 气压弹道碎石； 输尿管结石； ESWL [中图分类号] R693[文献标识码] A[文章编号] 1673-9701（2009）12-63-02 Extracorporeal Shock-wave Lithotripsy Therapy of Ureteral Calculi without Responding to Treatment with Transureteroscopic Pneumatic Lithotripsic JIANG RongcaiYE ZhihuaXIAO Aihua Daye Traditional Chinese Medicine Hospital，Hubei 435100 [Abstract] Objective To evaluate extracorporeal shock-wave lithotripsy（ESWL）in the treatment of ureteral calculi，in which treatment with transureteroscopic pneumatic lithotripsy was failed. Methods 23 cases of ureteral calculi，in which treatment with transureteroscopic pneumatic lithotripsy were failed，were treated with ESWL， to observe the effect of ESWL. Results 23 cases were treated successfully with well effect which showed stone free with urine. The DJ tubes were pull out under cystoscope after 1~2 weeks.There were no retained calculus when KUB rechecked. Conclusion Treatment of inferior segment ureteral calculi with transureteroscopic pneumatic lithotripsy is better and effective. But to superior segment ureteral calculi is easy to fail because of upward displacement of the stone. ESWL should be the first choice for superior segment ureteral stone after treatment with transureteroscopic pneumatic lithotripsy is failed. [Key Words] Ureteral calculi； Transureteroscopic pneumatic lithotripsic； ESWL 输尿管结石的微创治疗方法目前主要包括ESWL、腹腔镜取石术和输尿管镜碎石术。而输尿管镜碎石术有超声碎石术、液电碎石术、气压弹道碎石术和激光碎石术等[1]。输尿管镜气压弹道碎石术是近年来用于泌尿外科腔内新技术，具有微创、不出血或出血少，痛苦轻微，直视下观察病变部位更准确等优点，目前已广泛应用于输尿管结石的治疗。但是结石上移常造成碎石失败，所以临床上需要及时采取补救治疗。笔者近期采用ESWL补救治疗气压弹道碎石术失败的输尿管结石患者23例，取得很好的临床效果，现报道并分析如下。 1材料与方法 1.1研究对象 2008年3~12月气压弹道碎石术失败的输尿管结石患者23例，其中男性16例，女性7例，年龄24~65岁，平均年龄41.2岁；输尿管中下段结石3例，输尿管上段结石20例；结石大小0.6~1