Tawfiek E R, Bagley D H
Department of Urology, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania 19107, USA.
Urology. 1999 Jan;53(1):25-31. doi: 10.1016/s0090-4295(98)00462-2.
To evaluate our experience in treating 155 patients with upper urinary tract calculi ureteroscopically. The treatment of urinary calculi has remained the most frequent application of ureteroscopy. Miniaturization of semirigid and flexible ureteroscopes has permitted easier access to calculi throughout the urinary tract.
Ureteroscopic stone treatment was attempted in 155 patients with upper urinary tract calculi between November 1995 and March 1997. Fifty-nine (38.1%) patients had renal calculi, 82 (52.9%) ureteral, and 14 (9%) had both renal and ureteral calculi. Both semirigid and flexible ureteroscopes were used for treatment (rigid alone in 21 [13.5%], flexible in 64 [41.3%], and both rigid and flexible in 70 [45.2%] patients). Lithotripsy was required in 122 (79%) of the patients. The holmium:yttrium-aluminum-garnet laser was used in 113 (92.6%) of these patients.
All patients with ureteral calculi (29 proximal, 19 mid, and 34 distal) were successfully cleared after one endoscopic procedure except for 1 patient with a proximal ureteral calculus who had a 4-mm residual fragment in the kidney. Of the 59 patients with renal calculi, 47 (79.7%) were totally clear of stones 1 month after treatment. The remaining 12 (20.3%) patients had evidence of residual calculi 3 to 4 mm or less in diameter. In patients with combined renal and ureteral calculi, 1 1 of 14 (78.6%) were rendered stone free. The remaining 3 (21.4%) patients had evidence of residual calculi 4 mm in diameter. Overall, 95% of the patients were treated in an outpatient setting. Morbidity was low, with no evidence of stricture.
Ureteroscopy and laser lithotripsy in experienced hands are a safe and reliable method for the treatment of ureteral and even intrarenal calculi.
评估我们运用输尿管镜治疗155例上尿路结石患者的经验。尿路结石的治疗一直是输尿管镜最常见的应用领域。半硬性和软性输尿管镜的小型化使得在整个尿路中更容易接近结石。
1995年11月至1997年3月期间，对155例上尿路结石患者尝试进行输尿管镜取石治疗。59例（38.1%）患者有肾结石，82例（52.9%）有输尿管结石，14例（9%）既有肾结石又有输尿管结石。半硬性和软性输尿管镜均用于治疗（仅用硬性输尿管镜21例[13.5%]，软性输尿管镜64例[41.3%]，硬性和软性输尿管镜联合使用70例[45.2%]）。122例（79%）患者需要进行碎石术。其中113例（92.6%）患者使用钬:钇铝石榴石激光。
除1例近端输尿管结石患者肾脏内残留4毫米碎片外，所有输尿管结石患者（29例近端、19例中段和34例远端）经一次内镜手术均成功清除结石。59例肾结石患者中，47例（79.7%）在治疗1个月后结石完全清除。其余12例（20.3%）患者有直径3至4毫米或更小的残留结石迹象。在既有肾结石又有输尿管结石的患者中，14例中有11例（78.6%）结石清除。其余3例（21.4%）患者有直径4毫米的残留结石迹象。总体而言，95%的患者在门诊接受治疗。发病率较低，无狭窄迹象。
在经验丰富的医生手中，输尿管镜检查和激光碎石术是治疗输尿管结石甚至肾内结石的一种安全可靠的方法。
