经尿道输尿管镜下气压弹道碎石取石212例  

Research on 212 cases of URSL and calculus removing by calcusplt through urethra under ureteroscope

作　　者：陈世伟[1] 赵轶[1] 

机构地区：[1]解放军第174医院泌尿外科,福建厦门361003

出　　处：《临床军医杂志》2010年第5期719-720,共2页Clinical Journal of Medical Officers

摘　　要：目的 探讨提高输尿管镜下弹道碎石的成功率及减少并发症的方法.方法 212例输尿管结石,采用4号输尿管导管引导下在液压灌注下直接进镜,输尿管导管于结石上方向下冲洗,配合体位行弹道碎石,术后放置双J管.结果 手术时间15～90 min,平均30 min,碎石成功率99%.术后7 d 摄X线片,结石排净率93%.对>6 mm 以上结石行ESWL.术后1个月根据排石情况拔除双J管.术中出现输尿管口膀胱壁损伤造成进镜困难4例;输尿管穿孔3例;予留置双J管3个月.无输尿管撕脱等严重并发症.结论 采用4号输尿管导管引导下在液压灌注下直接进镜,输尿管导管于结石上方向下冲洗,配合体位行弹道碎石,损伤小、疗效好、并发症少.Objective To explore methods to increase the success rates of URSL by calcusplt through urethra under ureteroscope,and reduce its complication.Methods 212 cases of patients who suffered from ureteral calculus were chosen.They were directly taken into ureteroscope inducted by 4 type ureteral catheter with hydraulic pressure perfusion.Their ureters were douched from the top down around the calculi,and match their position to carry out URSL.Then,dual J tubes were placed after the operations.Results Operations lasted from 15 to 90 min,success rate were 99%.X-ray examination 7 d after operation showed that calculus evacuation rate was 93%,calculi which diameter bigger than 6mm were carried out with ESWL.Dual J tubes were removed 1 month after the operations.4 cases have injury in ureterostoma and wall of urinary bladder,leading to the difficulties in taking into ureteroscope;3 cases with uretaral perforate,their dual J tubes were placed for 3 month.No serious complications such as ureterostoma avulsion occured.Conclusion The methods of directly taking into ureteroscope inducted by 4 type ureteral catheter with hydraulic pressure perfusion,douching from the top down around the calculi,and matching their position to carry out URSL is well-effective,have the advantages of little injury,good clinical effect,less complication.

关 键 词：经尿道输尿管镜 气压弹道碎石 取石 输尿管导管 输尿管结石 严重并发症 术后 成功率 膀胱壁损伤 液压 体位 输尿管口 手术时间 灌注 方法 冲洗 排净率 留置双 min 排石 

分 类 号：R82[医药卫生—临床医学]