逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石的疗效比较.doc

逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石的疗效比较 .doc逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石的疗效比较
王炜王谷丰蒋国华温洪波甄旭彦
【摘要】目的比较逆行与顺行输尿管镜术处理输尿管上段嵌顿性结石的疗效,并对其安全性与有效性进行评价。方法采用输尿管镜术共治疗输尿管上段嵌顿性结石246例,其中逆行经尿道入路治疗186例,顺行经皮肾微造瘘入路60例。结果逆行经尿道入路手术成功173例(93%),平均手术时间35min,平均住院时间5d,%,22例需ESethods A total of 246 patients pacted upper ureteric calculi ed via retrograde transurethral access in 186 patients and via antegrade percutaneous nephrostomy tract in 60 patients. Results The ess rate of retrograde approach e in ean hospital stay of 5 days. The stone free rate onth folloe in ean hospital stay of 8 days. The stone free rate pacted upper ureteric calculi are safe and effective. ess rate and stone free rate of antegrade approach are higher than those of the retrograde approach.
KEY y tract
输尿管上段嵌顿性结石单用体外冲击波碎石(ESol/L。
治疗方法逆行经尿道入路用8/ F的输尿管硬镜(Richard m小碎片取出,-5 F双“J”管;顺行经皮肾微造瘘入路中患侧逆行插入4-5F输尿管导管,俯卧位,在C臂X线定位下穿刺(肾积水明显者,不须X线定位,可直接穿刺),穿刺点多选择12肋上经中盏或上盏入路。用18G肾穿刺针穿刺成功后,引入斑马导丝,沿斑马导丝以筋膜扩张器从8F开始,递增扩张至14-16F,留置14F或16F的Peelam×7mm至10mm×25mm,平均8mm×18mm。手术成功173例(93%),平均手术时间35min(25-60min),平均住院时间5d(4-9d)。%(151/183),22例复查时仍有较大残石,行ESm×7mm至12mm×30mm,平均9mm×17mm。手术成功60例(100%),平均手术时间55min(30-90min),平均住院时间8d(6-12d)。术后1个月复查无石率100%(60/60)。无手术并发症发