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目的 :探讨上尿路结石ESWL治疗失败的原因及再手术的临床效果。方法 :对 12例ESWL治疗失败的患者进行了肾脏切除术 3例 ,肾盂切开加输尿管切开取石术 2例 ,肾盂切开取石 3例 ,输尿管切开取石术 4例。结果 :再手术的原因为肾结石 3例 ,结石残留合并脓肾 1例 ,肾结石伴肾萎缩 1例 ,肾多发结石及同侧输尿管整段石串 1例 ,肾盏结石粘附肾孟 1例 ,急性肾衰 1例 ,输尿管结石致肾积水加重 2例 ;手术后无 1例死亡 ,肾功能不全均有不同程度改善。结论 :要严格掌握ESWL的适应症 ,规范化碎石 ,避免盲目性 ,及时地处理ESWL治疗后排石过程中可能出现的并发症。
Objective: To investigate the causes of failure of ESWL in upper urinary calculi and the clinical effect of reoperation. Methods: 12 cases of failed ESWL patients underwent nephrectomy in 3 cases, pyelolithotomy plus ureterolithotomy in 2 cases, pyelolithotomy in 3 cases and ureterotomy in 4 cases. Results: Reoperation was caused by kidney stones in 3 cases, residual stones with residual pus in 1 case, renal stones with renal atrophy in 1 case, multiple renal calculi and ipsilateral ureteral stones in 1 case, calyceal calculus adhered to kidney 1 Cases, acute renal failure in 1 case, hydronephrosis caused by ureteral calculi in 2 cases; no death after surgery, renal insufficiency have varying degrees of improvement. Conclusion: The indications of ESWL should be strictly controlled, the lithotripsy should be standardized, the blindness should be avoided, and the complications that may appear during the row of stone after ESWL treatment should be promptly treated.