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目的 报告小儿输尿管结石URS和ESWL治疗经验 ,探讨微创治疗的效果和策略。方法 复习了 1988～ 2 0 0 3年间 6 5例小儿输尿管结石的治疗和结果 ,其中 2 2例患儿应用ESWL治疗 ;4 3例输尿管中、下段结石和 5例上段嵌顿结石ESWL失败者进行了输尿管镜治疗 ,用APL弹道碎石机或钬激光击碎结石并取出 ,7例联合ESWL ;1例接受了开放手术。结果 2 2例输尿管上段结石经过 2 9次ESWL治疗 ,随访 3个月 ,结石完全排空 16例 ,完全排空率为 72 .7%。 4 3例输尿管中、下段结石和 5例上段嵌顿结石ESWL失败者进行了 4 8次输尿管镜治疗 ,,4 7次进镜治疗成功。 30例下段结石URS治疗均成功 ;13例中段结石 ,10例URS取石成功。 3例中段结石和 4例上段结石联合ESWL碎石均成功 ,4 5例术后停留引流管 1～ 4周 ,随访 3个月 ,结石清除率为 97.9%。 1例上段结石入镜失败改行开放手术取石。结论 ESWL仍是输尿管上段结石的首选治疗方法 ;对输尿管中、下段结石特别是下段结石应用小直径输尿管镜则是安全有效的方法 ;部分中、上段结石采用URS联合ESWL效果可能更好。
Objective To report the experience of pediatric ureteral calculi treated with URS and ESWL and to explore the effect and strategy of minimally invasive treatment. METHODS: Twenty-five children with ureteral calculi underwent ESWL treatment from 1988 to 2003. Twenty-three children with ESWL were enrolled in the study. 43 patients with lower ureteral stones and 5 failed upper ESWL incarcerated Ureteroscopic treatment with APL ballistic lithotripsy or holmium laser crushed stones and removed, 7 cases combined with ESWL; 1 case underwent open surgery. Results Twenty-two patients with upper ureteral calculi underwent ESWL for 29 months. All patients were followed up for 3 months. Totally 16 patients had complete emptying of stones and the complete emptying rate was 72.7%. Forty-four ureteroscopic ureteral calculi were performed in 43 cases of lower ureteral calculi and 5 cases of unsuccessful upper ESWL incarcerated stones. 30 cases of lower URS stone therapy were successful; 13 cases of middle stone, 10 cases of URS stone success. Three cases of middle stone and four cases of upper stone combined with ESWL gravel were successful, 45 cases of drainage tube drainage after 1 to 4 weeks, followed up for 3 months, stone clearance rate was 97.9%. One case of upper stump into the mirror failed to divert open surgery stone. Conclusions ESWL is still the first choice for the treatment of upper ureteral calculi. It is safe and effective to use small diameter ureteroscope in the middle and lower ureteral calculi, especially in lower ureteral calculi. In some cases, URS combined with ESWL may be more effective in the upper and lower calculi.