输尿管封堵取石导管结合钬激光在输尿管中上段结石治疗中的应用

Stone Cone封堵取石导管在输尿管结石治疗中的应用目的：评价Stone Cone封堵取石导管治疗输尿管结石的临床效果.方法：入选36例输尿管结石患者，上段结石24例，中段结石4例，下段结石8例。

均使用Stone Cone封堵取石导管并配合钬激光碎石。

随机抽取既往输尿管结石50例，上段结石2例，中段结石13例，下段结石35例。

术中配合使用钬激光，未采用任何封堵导管。

术后第2天复查KUB平片以评价手术效果.结果：两组手术患者术中均成功击碎结石并留置输尿管双J管。

前者有2例结石漂移至肾内，均为靠近肾盂输尿管连接部结石，后予辅助体外冲击波碎石。

余结石均成功碎石，无明显结石残留。

后者发生结石漂移至肾内8例，均为中上段结石，结石残留率较高。

两组病例在一期结石取净率和手术时间在统计学上有显著差异.结论：Stone Cone 封堵取石导管可有效减少结石漂移，提高输尿管钬激光碎石一期结石取净率，并可显著缩短手术时间，提高手术的安全性。

具有较高的临床应用价值。

标签：输尿管结石钬激光输尿管封堵导管随着腔镜泌尿外科的发展，输尿管镜下碎石已成为输尿管中下段结石外科治疗的首选方式，但对于上段输尿管结石，则采取何种手术方式有一定争议。

单纯输尿管镜碎石在处理上段结石存在着结石容易漂移至肾内而致手术效果欠佳。

而采用腹腔镜或肾镜又增加手术的创伤性，甚至导致严重的并发症。

封堵取石导管的出现，有效的减少输尿管镜碎石中结石漂移，大大提高手术成功率。

我院自2014年6月至2014年8月，对36例输尿管结石患者采用Stone Cone封堵取石导管并配合钬激光碎石，效果显著，现报告如下。

1资料与方法1.1 一般资料封堵取石导管组入选输尿管结石患者36例，年龄34～72岁，平均46岁，男性26例，女性10例。

上段结石24例，中段结石4例，下段结石8例。

结石大小约1.2cm～1.8cm，其中长段石街2个，最长4cm，位于上段输尿管。

输尿管扩张0.7cm～1.4cm。

封堵导管结合钬激光在输尿管镜下治疗输尿管上段结石的应用目的：探讨封堵导管结合钬激光在输尿管镜下治疗输尿管上段结石的应用效果。

方法：回顾性分析在输尿管镜钬激光碎石术中使用封堵导管的152例输尿管上段结石患者的临床资料。

结果：152例中，143例一次碎石成功（94.1%），术中结石漂移至肾盂或肾盏内8例（5.2%），1例因输尿管上段扭曲输尿管镜无法进入。

其中143例患者，将结石粉碎至约2 mm左右，无明显手术并发症，术后2～4周复查CT未见明显碎石。

结论：封堵导管结合钬激光在输尿管镜下治疗输尿管上段结石可减少结石上移，提高结石清除率，值得临床推广。

[Abstract] Objective：To investigate the effect of transcatheter closure combined with holmium laser lithotripsy in the treatment of upper ureteral calculi.Method：Retrospective analysis of clinical data of 152 patients with upper ureteral calculi who were treated with transcatheter closure of ureteral calculi with holmium laser lithotripsy.Result：In 152 cases，there were 143 cases of a graveled success （94.1%）.There were 8 cases（5.2%）with stones drifting to the renal pelvis or renal calyx during the operation. And 1 case was unable to enter because of ureter distortion.Among the 143 patients，crushed stones to about 2 mm or so，without obvious surgical complications.After 2 to 4 weeks，there were no obvious crushed stones on CT.Conclusion：Transcatheter closure combined with holmium laser lithotripsy in the treatment of upper ureteral calculi can reduce the stone up and improve the stone clearance rate，isworth of clinical promotion.[Key words] Upper ureteral calculi；Transcatheter closure；Holmium laser lithotripsy；Ureteroscope輸尿管镜钬激光碎石术治疗输尿管结石在临床上已广泛应用，可是对于输尿管上段结石，因碎石过程中容易上移至肾盂内，所以碎石成功率、清除率不是很高。

输尿管封堵导管在输尿管中上段结石钬激光碎石中的应用郝继东;廖国强;邓晓俊;刘辉;刘峰;王伟峰【摘要】目的：探讨输尿管封堵导管在输尿管中上段结石钬激光碎石(URL)治疗中的有效性及安全性。

方法回顾性分析上海健康医学院附属周浦医院泌尿外科2011年8月至2015年9月期间收治的120例输尿管中上段结石使用封堵导管行URL患者的临床资料。

结果120例患者中112例成功粉碎结石，结石清除率为93.3%，其中3例术中未能成功封堵结石，结石漂移至肾孟，术中留置双J管，后两期行输尿管软镜碎石。

还有1例患者输尿管结石较大且嵌顿明显，输尿管周围无空隙叶片无法绕过结石，术中出血视野模糊，后行输尿管切开取石。

另外4例术后复查有输尿管结石残留术后补充行体外震波碎石(ESWL)或再次行输尿管硬镜碎石，所有患者均无输尿管黏膜撕脱及输尿管穿孔等严重并发症。

结论输尿管封堵器协助治疗输尿管中上段结石方法有效，操作简便，减少结石移动，提高结石清除率，不增加手术并发症，具有良好的临床应用价值。

%Objective To explore the curative effectiveness and safety of ureteral occlusion device in uretero-scopic holmium laser lithotripsy for upper ureteral stones. Methods The clinical data of 120 patients admitted to De-partment of Urology of Zhoupu Hospital Affiliated to Shanghai University of Medicine and Health Sciences from Au-gust 2011 to September 2015, who underwent ureteral occlusion device combined with ureteroscopic holmium laser lith-otripsy for upper ureteral stones, was retrospectively analyzed. Results The calculi of 112 cases among the 120 patients were smashed successfully with a clearance rate of 93.3%. Calculi in three cases were not occluded successfully during op-eration and shifted to renal pelvis. The double J tube was placed duringthe operation and flexible ureteroscope lithotripsy was operated in the last two-stage. Also there was one case that the blade can not be placed over the calculus for which was too big and obvious embedding, so that no space around the ureter cannot bypass the stone. There was bleeding caus-ing blurred vision. Then, the calculus was removed by incision of ureter. The other four cases with the remaining ureter cal-culi were operated with extracorporeal shock wave lithotripsy (ESWL) or rigid ureteroscope lithotripsy again. None of the patients had serious complications such as ureter mucosa avulsion or piercing. Conclusion Ureteral occlusion device is effective in assisting in ureteroscopic holmium laser lithotripsy for upper ureteral stones. This method is easy to operate and can reduce the movement of calculi, increase calculi clearance rate without increasing complications, and thus has a good clinical application value.【期刊名称】《海南医学》【年(卷),期】2016(027)015【总页数】3页(P2537-2538,2539)【关键词】输尿管中上段结石;封堵导管;钬激光【作者】郝继东;廖国强;邓晓俊;刘辉;刘峰;王伟峰【作者单位】上海健康医学院附属周浦医院泌尿外科，上海 201318;上海健康医学院附属周浦医院泌尿外科，上海 201318;上海健康医学院附属周浦医院泌尿外科，上海 201318;上海健康医学院附属周浦医院泌尿外科，上海 201318;上海健康医学院附属周浦医院泌尿外科，上海 201318;上海健康医学院附属周浦医院泌尿外科，上海 201318【正文语种】中文【中图分类】R693+.4输尿管结石是我国泌尿系统常见病之一。