Ohigashi T, Miyajima A, Uchida A, Jitsukawa S, Ueno M
Department of Urology, Urawa Municipal Hospital.
Nihon Hinyokika Gakkai Zasshi. 1995 Nov;86(11):1636-42. doi: 10.5980/jpnjurol1989.86.1636.
The objective of this study is to evaluate the efficacy of ureteroscopic lithotripsy as the treatment of ureteral stones in the recent era by comparing the result using a semirigid ureteroscope with the result using a conventional ureteroscope.
Between 1991 and 1994, 136 patients with ureteral calculi underwent transurethral ureteroscopic lithotripsy in our hospital. From July 1991 to March 1993, 14F rigid ureteroscope with the rod lens system was used for 82 patients (group 1), whereas from April 1993 to July 1994 either a 9.5F or 7F semirigid fiberoptic ureteroscope was used for 54 patients (group 2). Insertion of ureteroscopes was performed under continuous irrigation of saline without mechanical dilation of the ureteral orifice in both groups.
The rates of complete removal of stone at the first trial were 56.1% in group 1 and 72.2% in group 2 with the overall complete removal rate of 62.5%. The complete removal rates of stones in the upper, middle and lower ureters were 18.2%, 54.8% and 72.4% in group 1 and 14.3%, 72.7% and 88.0% in group 2, respectively. The major reasons for unsuccessful treatments was upward migration of stones during the procedure. As intraoperative complications, ureteral disruption occurred in 1 case in group 1, and ureteral perforation in 5 patients in group 1 (6.1%) and 2 in group 2 (3.8%). Acute bacterial infection with prolonged fever was observed in 3 patients in group 1 and in none in group 2.
From these results, the new semirigid ureteroscope with fiberoptic imaging bundles made the transurethral lithotripsy a safer and more efficient procedure for the treatment of ureteral calculi especially those in the lower ureters.
本研究的目的是通过比较使用半硬性输尿管镜与传统输尿管镜的治疗结果，评估近年来输尿管镜碎石术治疗输尿管结石的疗效。
1991年至1994年间，136例输尿管结石患者在我院接受了经尿道输尿管镜碎石术。1991年7月至1993年3月，82例患者（第1组）使用带柱状透镜系统的14F硬性输尿管镜，而1993年4月至1994年7月，54例患者（第2组）使用9.5F或7F半硬性纤维输尿管镜。两组均在持续盐水冲洗下插入输尿管镜，未对输尿管口进行机械扩张。
第1组首次尝试结石完全清除率为56.1%，第2组为72.2%，总体完全清除率为62.5%。第1组输尿管上、中、下段结石的完全清除率分别为18.2%、54.8%和72.4%，第2组分别为14.3%、72.7%和88.0%。治疗失败的主要原因是术中结石上移。术中并发症方面，第1组有1例发生输尿管破裂，第1组有5例（6.1%）发生输尿管穿孔，第2组有2例（3.8%）发生输尿管穿孔。第1组有3例患者出现伴有持续发热的急性细菌感染，第2组无。
从这些结果来看，新型带纤维光学成像束的半硬性输尿管镜使经尿道碎石术成为治疗输尿管结石尤其是下段输尿管结石更安全、更有效的方法。
