王文明　贾书雷　杨　东

【摘要】 目的 探讨输尿管镜下气压弹道碎石术治疗输尿管结石的疗效。方法 应用输尿管镜下气压弹道碎石术治疗输尿管结石168例。男117例，女51例，年龄19~65岁，平均41岁。输尿管上段结石14例，中段61例，下段93例。结石直径0．6~2．4 cm，平均0．8 cm。结果 168例输尿管结石中，一次性碎石成功159例，占94．6%。碎石失败9例，占5．4%，其中5例输尿管上段结石移位至肾盂，留置双J管后行体外冲击波碎石(ESWL)治愈，另外3例进镜失败患者和1例输尿管穿孔患者均立即改行开放手术治愈。结论 输尿管镜下气压弹道碎石术治疗输尿管结石具有微创、安全、效果好等优点，可作为输尿管中、下段结石的首选治疗方法。

【关键词】输尿管结石；气压弹道碎石术；输尿管镜

Transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi

WANG Wen-ming，JIA Shu-lei，YANG Dong.Department of Urology,Chinese medicine hospital of Jiyuan city,Henan,454650 China

【Abstract】 Objective To investigate the effects of transureteroscopic pneumatic lithotripsy in the treatment of ureteral calculi.Methods 168 cases(117 men,51 women,age range 19~65 years,mean age 41 years)of ureteral calculi were treated with ureteroscopic pneumatic lithotripsy.Of them,14 patients had calculi in the proximal part of the ureter,61 in the middle part,93 in the distal part.The size of the stones ranged from 0．6 cm to 2．4 cm in diameter.Results 168 cases of ureteral stones were treated by ureteroscopic lithotripsy,of which 94．6%(159/168)were fragmented on the first treatment session and 5．4%(9/168)were unsuccessful.The proximal ureteral calculi were moved to renal pelvic and cured by extracorporeal shock wave lithotripsy(ESWL)after the double-J ureteral stunt was placed in 5 cases.Open surgery was the choice after the ureteral perforation in 1 cases and the failure of inserting the ureteroscope in 3 cases.Conclusion Treatment of ureteral calculi by transureteroscopic pneumatic lithotripsy has been less invasive,safe and effective,and should be the first choice to the patients with middle and low ureteral stones.

【Key words】Ureteral calculi; Pneumatic lithotripsy; Ureteroscopy

2003年4月至2007年9月，济源市中医院应用输尿管镜下气压弹道碎石术治疗输尿管结石168例，效果满意，现报告如下。

1 资料与方法

1．1 临床资料 本组168例，男117例，女51例，年龄19~65岁，平均41岁。结石位于左侧输尿管86例，右侧输尿管82例；输尿管上段结石14例，中段61例，下段93例。结石直径0．6~2．4 cm，平均0．8 cm.。全组均行IVP及B超检查，135例提示同侧肾积水及输尿管上段扩张。阳性结石152例，术中证实为阴性结石16例。结石停留时间1周~2年，平均5个月。其中53例曾行ESWL治疗失败，5例ESWL术后石街形成，3例急性梗阻性无尿。

1．2 治疗方法 应用德国产WolfF_8/9．8硬性输尿管镜，国产气压弹道碎石机及液压灌注泵。连续硬膜外麻醉，截石位。经尿道插入输尿管镜至膀胱，观察双侧输尿管开口位置，向患侧输尿管口插入F4输尿管导管做为引导，水压扩张输尿管口直接入镜。……