目的:探讨输尿管镜下应用输尿管管路封堵器联合钬激光治疗输尿管结石的安全性及有效性。方法:回顾性分析2010年11月~2013年3月采用英诺伟TMIVX-SC10输尿管管路封堵器联合钬激光治疗输尿管结石患者200例的临床资料:男123例,女77例,年龄19~67岁,平均38.1岁。左侧87例,右侧105例,双侧8例。输尿管中上段结石189例,输尿管下段结石11例。术中使用Wolf F8/9.8输尿管镜,先将管路封堵器叶片浸入生理盐水中5~10s,使管路封堵器亲水涂层润湿。然后插入输尿管镜,探及结石后将输尿管镜完全超越结石,于输尿管镜工作通道内安置输尿管管路封堵器,操作体外手柄使叶片折叠成球状,防止结石上移。将输尿管镜退到结石下方,术中采用50ml针筒注水,而后使用科瑞达钬激光以1.2~1.8J、10Hz功率完全击碎结石至直径2mm左右碎片,并使用封堵器叶片折叠球将结石碎片拖出输尿管开口。如结石较大或有息肉包裹,先用钬激光将息肉切除,从结石一侧碎出一通道,然后将输尿管镜超越结石。所有患者术后留置双J管2周。结果:术中出现结石漂移至肾脏2例,均未出现输尿管穿孔及输尿管黏膜损伤。术后出现畏寒发热1例,经抗炎补液等对症处理后好转。所有患者术后均复查血常规、肾功能,术后4周复查B超、KUB或上尿路螺旋CT平扫,发现只有3例患者存在有临床意义的残石(残石直径大于4mm),结石总清除率达91.4%。结论:输尿管管路封堵器是一种治疗输尿管结石安全有效的辅助工具,能显著减少输尿管镜碎石术中的结石漂移,同时能将碎石拖出输尿管腔道外,减少取石的进镜次数,缩短手术时间。 Objective: To investigate the safety and effectiveness of ureteroscopic ureter occluder combined with holmium laser in the treatment of ureteral calculi. Methods: The clinical data of 200 patients with ureteral calculi treated with ENOVX TMIVX-SC10 ureteral occluder combined with holmium laser during November 2010 to March 2013 were retrospectively analyzed. There were 123 males and 77 females, aged 19 ~ 67 years old, average 38.1 years old. 87 on the left, 105 on the right, and 8 on both sides. 189 cases of upper ureteral stones, 11 cases of lower ureteral stones. Intraoperative use of Wolf F8 / 9.8 ureteroscopy, the first occlusion of the pipe plug leaves immersed in saline for 5 ~ 10s, so that the hydrophilic pipe plug occluder wetting. Then insert the ureteroscope, exploration and stones after the ureteroscope completely beyond the stones in the ureteroscope working channel placed ureteral pipeline occluder, the operation of the outer handle folds the leaves into a ball to prevent the stones on the move. The ureteroscopy retreated below the stones, surgery using 50ml syringe water, and then use Kerui Da holmium laser to 1.2 ~ 1.8J, 10Hz power completely crushed stones to a diameter of about 2mm fragments, and the use of occluder leaf folding ball Stone fragments dragged out of the ureter opening. If the stones are larger or polyps wrapped, the first holmium laser polyps removed, crushed from the side of the stone a channel, and then the ureteroscopy beyond the stones. All patients were placed double J tube for 2 weeks after operation. Results: There were 2 cases of stones drifting into the kidney in the operation, no ureter perforation and ureteral mucosal injury were found. 1 case of chills and fever after surgery, anti-inflammatory rehydration and other symptomatic treatment improved. Blood routine and renal function were rechecked after operation in all patients. B-scan, KUB or upper urinary-tract CT scan were performed 4 weeks after operation. Only 3 patients had clinically significant residual stone (residual stone diameter> 4mm) Total stone clearance rate of 91.4%. Conclusion: Ureteral occluder is a safe and effective tool to treat ureteral calculi. It can significantly reduce the stone drift in ureteroscopic lithotripsy. At the same time, it can pull the gravel out of the ureteral lumen and reduce the number of taking the stone , Shorten the operation time.