CAJ | 학술논문

目的：总结输尿管镜气压弹道碎石术治疗输尿管结石的临床经验。方法回顾性分析我院1999年12月～2013年7月输尿管镜气压弹道碎石术治疗1180例输尿管结石的临床资料。硬膜外麻醉1100例，静脉复合麻醉72例，尿道黏膜表面麻醉8例。在F4输尿管插管或斑马导丝引导下，采用上挑法、旋转法或直入法等将输尿管镜置入输尿管口，使用1．2 mm气压弹道碎石金属探杆，空气压力泵气压2～3 kPa，以单脉冲或连续脉冲粉碎结石。结果置镜失败21例：8例因输尿管口狭窄，13例因输尿管严重扭曲；13例行开放手术或腹腔镜取石，8例行体外震波碎石（ ESWL ）。41例结石移位至肾盂改行ESWL，2例因并发症（1例输尿管部分断裂，1例输尿管套袖状撕脱）转开放手术，27例碎石失败自行选择其他治疗。碎石成功率92．3％（1089/1180）。输尿管损伤37例：黏膜下假道形成21例，穿孔9例，部分断裂5例，除1例急诊手术修补外均放置支架管治愈；输尿管套袖状撕脱2例，1例长段撕脱急诊手术修补，术后3个月死于其他疾病，1例撕脱1 cm，放置支架管3个月后痊愈。术后发热36例，腰痛160例，对症治疗好转。42例有较大碎石残留术后行ESWL。术后1个月结石排净1036例，结石排净率87．8％（1036/1180）；3个月后另有69例结石排净。994例随访3个月，1例死于其他疾病，超声及静脉肾盂造影提示肾盂轻度扩张25例，残余结石11例，其余患者未见异常。结论输尿管镜气压弹道碎石术结石排净率高，结合ESWL疗效满意。在导丝引导下采用下压上挑法置镜成功率高，F4输尿管导管作为导丝综合效果好，控制手术时间，术后留置双J管有利于减少并发症的发生。
목적：총결수뇨관경기압탄도쇄석술치료수뇨관결석적림상경험。방법회고성분석아원1999년12월～2013년7월수뇨관경기압탄도쇄석술치료1180례수뇨관결석적림상자료。경막외마취1100례，정맥복합마취72례，뇨도점막표면마취8례。재F4수뇨관삽관혹반마도사인도하，채용상도법、선전법혹직입법등장수뇨관경치입수뇨관구，사용1．2 mm기압탄도쇄석금속탐간，공기압력빙기압2～3 kPa，이단맥충혹련속맥충분쇄결석。결과치경실패21례：8례인수뇨관구협착，13례인수뇨관엄중뉴곡；13례행개방수술혹복강경취석，8례행체외진파쇄석（ ESWL ）。41례결석이위지신우개행ESWL，2례인병발증（1례수뇨관부분단렬，1례수뇨관투수상시탈）전개방수술，27례쇄석실패자행선택기타치료。쇄석성공솔92．3％（1089/1180）。수뇨관손상37례：점막하가도형성21례，천공9례，부분단렬5례，제1례급진수술수보외균방치지가관치유；수뇨관투수상시탈2례，1례장단시탈급진수술수보，술후3개월사우기타질병，1례시탈1 cm，방치지가관3개월후전유。술후발열36례，요통160례，대증치료호전。42례유교대쇄석잔류술후행ESWL。술후1개월결석배정1036례，결석배정솔87．8％（1036/1180）；3개월후령유69례결석배정。994례수방3개월，1례사우기타질병，초성급정맥신우조영제시신우경도확장25례，잔여결석11례，기여환자미견이상。결론수뇨관경기압탄도쇄석술결석배정솔고，결합ESWL료효만의。재도사인도하채용하압상도법치경성공솔고，F4수뇨관도관작위도사종합효과호，공제수술시간，술후류치쌍J관유리우감소병발증적발생。
Objective To summarize our clinical experience of the treatment of ureteral calculi with ureteroscopic pneumatic lithotripsy. Methods The clinical data of 1180 cases of uteteral calculi treated by ureterocopic pneumatic lithotripsy from December 1999 to July 2013 were analyzed retrospectively .Epidural anesthesia was performed in 1100 cases, intravenous anesthesia in 72 cases, and urethral mucosal surface anesthesia in 8 cases.Under the guide of F4 ureteral catheter or zebra guide wire , we placed ureteroscopy into the ureter using the "pick-up"method,"rotation"method or"straight"method, and crushed the stones using the 1.2 mm metal probe , with the air pressure pump pressure being 2-3 kPa and single or continuous pulse . Results Ureteroscope insertion failed in 21 cases because of ureteral stenosis in 8 cases and ureter distortions in 13 cases, and they were treated afterwards by open or laparoscopic surgery(13 cases) and ESWL(8 cases) respectively.Forty-one cases recieved ESWL due to the shift of the stones to the renal pelvis , 2 cases underwent open surgery due to complications ( 1 case of partial rupture of the ureter and 1 case of ureter avulsion), and 27 cases chose other treatment after operation failure .The successful rate of lithotripsy was 92.3% (1089/1180). Thirty-seven cases were complicated with ureter injury including perforation (9 cases), urethral submucosa pseudocanal (21 cases), and partial fracture ( 5 cases ) .One case was treated by open surgery and the others by placement of double -J.Two cases were complicated with ureter avulsion .One case was treated by open surgery and died of other diseases 3 months later, and the other was cured by the placement of double-J.Thirty-six cases suffered from fever , 160 cases suffered from lumbago and all the symptoms were relieved after respective treatment .Forty-two cases were treated by ESWL due to residual stones .A total of 1036 cases (87.8%, 1036/1180) were stone-free 1 month after the surgery;another sixty-nine cases were stone-free 3 months after operation .A total of 994 cases were followed up for 3 months.One patient died of other disease; ultrasound and intravenous urography showed mild hydronephrosis in 25 cases, residual stones in 11 cases, and the remaining cases recovered well . Conclusions Ureteroscopic pneumatic lithotripsy is an effective procedure for ureteral calculi .The effect is more satisfactory when combined with ESWL .Placing ureteroscopy into the ureter with the method of downward press and pick-up under the guide wire is feasible and effective .The application of F 4 ureteral catheter as guide wire obtains good results .Good control of the operative time and postoperative D-J tube replacement could reduce the incidence of complications .