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目的总结输尿管镜下气压弹道碎石术并发症的处理经验。方法回顾性分析2002年5月～2007年12月660例经尿道输尿管镜取石术中发生25例并发症的临床资料。结果输尿管穿孔22例:13例顺利将结石击碎并将双J管越过穿孔处一端置入肾盂内;4例手术取石并修补输尿管;5例拒绝开放手术,术后出现不同程度的发热、腰痛、血尿等症状,3例经皮肾穿刺造瘘后症状好转,2例经皮穿刺肾造瘘失败待病情稳定后行开放手术治疗。输尿管撕断2例,术中开放行输尿管端端吻合术。输尿管下段穿孔至盆腔卵巢静脉血管出血1例,术中开放手术结扎破裂的血管。25例经积极对症处理后均痊愈出院。术后2个月顺利拔除双J管,术后1年行静脉肾盂造影检查无输尿管狭窄、梗阻。结论输尿管镜下气压弹道碎石术后近期输尿管损伤通过输尿管内支架引流管或经皮穿刺肾造瘘改道处理,可降低再次手术发生率;果断及时的开放手术可以避免更为严重并发症的发生。
Objective To summarize the treatment experience of ureteroscopic pneumatic lithotripsy. Methods The clinical data of 25 cases of complications occurred in 660 cases of transurethral ureteroscopic lithotomy were retrospectively analyzed from May 2002 to December 2007. Results of ureter perforation in 22 cases: 13 cases of stone crushing and double J tube across the perforation at one end into the renal pelvis; 4 cases of stone surgery and ureter repair; 5 cases refused to open surgery, postoperative fever, low back pain , Hematuria and other symptoms, 3 cases of percutaneous nephrostomy fistula improved, 2 cases of percutaneous puncture nephrostomy failure to be stable after open surgery. Ureteral torn in 2 cases, intraoperative open ureter end anastomosis. Lower ureteral perforation to pelvic ovarian vein bleeding in 1 case, intraoperative open ligation of ruptured blood vessels. Twenty-five cases were cured after positive symptomatic treatment. Two months after the successful removal of double J tube, 1 year after intravenous pyelography without ureteral stricture, obstruction. Conclusion ureteroscopic pneumatic lithotripsy after ureteral injury through ureteral stent drainage or percutaneous nephrostomy diversion treatment can reduce the incidence of reoperation; decisive timely open surgery can avoid the occurrence of more serious complications .