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目的 :探讨提高输尿管镜腔内碎石治疗上尿路结石疗效的操作技巧。方法 :经尿道输尿管镜直视下采用气压弹道机碎石治疗 31 5例 32 5侧上尿路结石。结果 :碎石取石成功 30 3侧。 2例并发输尿管穿孔 ,2例因结石合并严重的炎性息肉术中出血致视野不清碎石困难改开放手术取石 ,输尿管严重扭曲折叠 3例进镜困难而放弃碎石 ,4例因输尿管开口偏向头侧不能入镜至输尿管腔内 ,1 1例输尿管上段结石上移至肾盂内行ESWL治疗。结论 :输尿管镜腔内碎石安全有效 ,并发症少 ,充分术前准备、选择合适病例 ,术中仔细操作、配合体位调节 ,充分运用安全导丝、输尿管导管和套石蓝等是提高输尿管镜腔内碎石疗效减少并发症的关键。
Objective: To explore the operative techniques to improve the efficacy of ureteroscopic lithotripsy in the treatment of upper urinary tract calculi. Methods: Transurethral ureteroscopy with pneumatic lithotripsy was used to treat 31 5 cases of 32 5 upper urinary tract stones. Results: Gravel stone successfully 30 3 side. 2 cases complicated with ureter perforation, 2 cases due to stones with severe inflammatory polyp bleeding in the field of vision caused by unclear gravel difficult to change the open surgery stone, ureter serious twisting and folding in 3 cases into the mirror difficult to give up gravel, 4 cases due to ureteral orifice Biased toward the head side can not enter the ureter cavity, 11 cases of upper ureteral calculi moved to the renal pelvis ESWL treatment. Conclusions: Ureteroscopic lithotripsy is safe and effective, with few complications, adequate preoperative preparation, proper choice of cases, careful operation in operation, coordination with body position adjustment, safe use of guidewires, ureteral catheterization, Endovascular treatment of complications to reduce the key.