【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失败的原因。方法对10例行输尿管镜下气压弹道碎石术治疗输尿管结石失败的临床资料进行回顾性分析。结果本组10例中4例因置镜受阻转开放手术取石,其中输尿管扭曲或狭窄3例、输尿管开口异常1例;操作时结石上移进入肾盂4例,致手术失败,术中放置双J管后行体外冲击波碎石;结石息肉包裹1例,镜下无法看清结石,转开放手术取石;术中输尿管穿孔致手术失败1例,转开放手术取石,同时行输尿管原位修补术。结论输尿管扭曲狭窄、输尿管开口异常、结石移位、结石息肉包裹及输尿管穿孔是输尿管镜下气压弹道碎石失败的常见原因;合理选择病例及谨慎、熟练操作是手术成功的关键。更多还原

【Abstract】 Objective To explore the cause of failure of ballistic lithotripsy under ureteroscope in treatment of ureteral calculi. Methods Clinical data of 10 unsuccessful cases of ureteral calculi treated with ballistic lithotripsy under ureteroscope was retrospectively analyzed. Results Of the 10 cases,4 were terminated because of the blocked ureteroscopes,and instead underwent open surgery for calculus removed during putting into ureteroscopes,and the ureters were tortuosity or narrowness in 3 cases,and 1 with abnormal ureter hole; during the operations,4 cases were terminated because of stone migration to renal pelvis,and then were inserted with double J tubes for extracorporeal shock wave lithotripsy; 1 case failed for unclear calculus under ureteroscopes because of calculus were wrapped with the polypus,and then the open surgery was undertaken; 1 case failed because of ureteral perforation,and then the open surgery and kposthesis in situ were performed at the same time. Conclusion The main causes of failure ballistic lithotripsy under ureteroscope in treatment of ureteral calculi are tortuous,narrow,abnormal ureter hole,stone migrations,polypus wrapping and ureteral perforation; the key of success depends on appropriate selection of cases and surgical skills.更多还原