输尿管镜气压弹道碎石术临床疗效观察及并发症探讨  

Clinical observation of transureteroscopic pneumatic lithotripsy and a discussion of recurrence

作　　者：彭伟[1] 张青汉[1] 董能本[1] 叶绪龙[1] 潘卫斌[1] 姜卫东[1] 桂定文[1] 陈小刚[1] 

机构地区：[1]湖北省黄石市中心医院泌尿外科,湖北黄石435000

出　　处：《中国内镜杂志》2006年第10期1062-1063,1066,共3页China Journal of Endoscopy

摘　　要：目的探讨输尿管镜气压弹道碎石术的疗效、预防及并发症。方法回顾性分析经输尿管镜气压弹道碎石术治疗的227例输尿管结石患者的临床资料,统计碎石成功率及分析12例并发症原因。结果一次性碎石成功率94.7%(215/227)。其中输尿管上段结石成功率为82.2%(37/45),中段结石为96.6%(57/59)、下段结石为98.4%(12l/123),术后1～3个月结石排净率为100%。随访时间为2～15个月,复查B超显示肾积水减轻或消失,部分病人复查KUB十IVU未发现输尿管狭窄。并发症发生率为6.2%,主要发生在技术开展的初期。结论该技术成功的关键在于好的输尿管置镜技巧、保持术野清楚、结石适当固定、冲水压力的控制以及碎石操作的技巧。该技术是目前治疗输尿管结石的一种安全、有效、微创的方法,尤其适用于输尿管中下段结石。[Objective] A discussion of how to improve the procedure of Transureteroscopic Pneumatic Lithotripsy; the prevention of, and reduction of recurrence. [Methods] A re-evaluation and analysis of 227 case materials of patients who had been treated by Transureteroscopic Pneumatic Lithotrlpsy （TPL） for Ureteral Calculi.（UC）; a statistical analysis of successful treatment of calculi and an analysis of 12 cases of recurrence. [Results] First-time suc- cess rate achieved 97% （215/227）. Among these success, 82.2% are of upper segmental UC （37/45）; a middle segmental UC success rate of 96.6% （57/59）; and a lower segmental UC success rate of 98.4% （121/123）, post-operative follow up during the period of 1-3 months showed a 100% success rate of complete removal. In subsequent followups over a period of 2-15 months using B ultrasound examination showed fluid buildup on the kidney either reduced or eliminated. A few patients were re-examined using KUB＋IVU and there was no incidence of urethral narrowing. Reoccun＇ence was limited to 6.2% of cases, which were mostly due to events in the first stages of the procedure. [Conclusion] The overall success rate using this procedure was due to proper alignment of the transureteroscope, maintenance of a clear view of the insertion, the stability of the calculi, maintenance of proper pneumatic pressure and calculi manipulation and complete removal. This procedure is a method for the safe, effective and reduction of patient injury in removing calculi, especially for middle and lower segmental procedures.

关 键 词：输尿管镜 气压弹道碎石术 临床疗效 并发症 输尿管结石 

分 类 号：R693.4[医药卫生—泌尿科学]