输尿管末端结石的诊治(附486例报告)

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摘要 目的:探讨和提高输尿管末端结石的诊断及治疗方法。方法:回顾性分析2007年9月~2014年7月收治的486例输尿管末端结石患者临床资料。282例患者首先行药物排石治疗,204例患者首先行输尿管镜碎石术或联合经尿道输尿管口切开术治疗,对62例药物治疗无效的患者也行手术治疗。记录患者结石排出率、结石排出时间、手术成功率、手术时间和术后住院天数等指标并记录不良事件发生情况。结果:行药物排石的282例患者中,220例(78.9%)结石成功排出,平均排石时间为(9.6±3.8)d。其中,结石直径≤8 mm的患者,结石排出率88.0%(139/158);结石直径＞8 mm的患者结石排出率为65.3%(81/124),两者比较差异有统计学意义(P=0.000)。266例手术患者手术均成功。手术时间为13~78 min,平均(39.2±13.4)min。术后住院天数为1~8 d,平均(4.1±1.7)d。术后不良事件发生率为1.9%(5/266例)。患者随访1~83个月,没有膀胱输尿管反流、输尿管狭窄等远期并发症发生。结论:对于直径≤8 mm的输尿管末端结石,可先行药物排石治疗。对于直径＞8 mm的输尿管末端结石,输尿管镜碎石术安全、有效。经尿道输尿管口切开术是治疗进镜困难的输尿管末端结石患者的较理想的术式。

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	徐遵礼
	张前兴
	朱建平
	马利英
	曾昊

关键词 ：输尿管末端结石, 输尿管镜碎石术, 输尿管口切开术

Abstract：Objective: To investigate and improve the diagnosis and treatment of distal ureteral calculi. Methods: The clinical data of 486 cases of distal ureteral calculi from Sep. 2007 to July 2014 in our hospital were analyzed retrospectively, including 282 cases treated by medication firstly, and 204 cases treated by ureteroscopic lithotripsy or ureteral meatotomy firstly. The outcomes were measured with rate of stone clearance, time of caluli expulsion, successful rate of operation, operation time and hospital stay after operation in patients. Adverse effects were recorded. Results: The rate of stone clearance was 78.9% (220/282 cases) in patients who underwent medication, and the mean time of caluli expulsion was (9.6±3.8) days. The rate of stone clearance was 88.0% (139/158) in patients with the diameter of distal ureteral calculi being under 8 mm, and 65.3% (81/124) in the patients with the diameter of distal ureteral calculi being larger than 8 mm (P=0.000). Of all the 266 cases undergoing surgical operation, the successful rate was 100%. The operation time was 13.78 min (mean 39.2±13.4 min), and the hospital stay after operation was 1.8 d (mean 4.1±1.7 d). The incidence of postoperative complications was 1.9% (5/266 cases). The patients were followed up for 1 to 83 months, and no long-term complications such as regurgitation or stenosis of the ureter occurred. Conclusions: Medication is a good choice for the treatment of the distal ureteral calculi (≤8 mm). Ureteroscopic lithotripsy is safe and efficiency for the treatment of the distal ureteral calculi (>8 mm). Transurethral ureteral meatotomy is an optimal treatment for the patients with difficulties in the ureteroscope insertion.

Key words： distal ureteral calculi ureteroscopic lithotripsy ureteral meatotomy

收稿日期: 2014-10-09

ZTFLH:

R693.4

通讯作者: 徐遵礼,xuzunli@163.com

引用本文:

徐遵礼,张前兴,朱建平,马利英,曾昊. 输尿管末端结石的诊治(附486例报告)[J]. 微创泌尿外科杂志, 2018, 7(s1): 17-.
Xu Zunli,Zhang Qianxing,Zhu Jianping,Ma Liying,Zeng Hao. Diagnosis and treatment of 486 cases of distal ureteral calculi. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(s1): 17-.

链接本文:

http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1396.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/Is1/17

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