Knispel H H, Klän R, Heicappell R, Miller K
Department of Urology, Benjamin Franklin Medical School, Free University, Berlin, Germany.
J Endourol. 1998 Dec;12(6):513-5. doi: 10.1089/end.1998.12.513.
Although extracorporeal shockwave lithotripsy (SWL) is a successful treatment for ureteral calculi, introduction of miniureteroscopes has advanced endoscopic management. We combined the use of a semirigid ureteroscope with a pneumatic lithotripter (Swiss Lithoclast) for the treatment of ureteral calculi. From January 1992 to August 1994, 143 patients (87 male, 56 female; mean age 48.7 years; age range 22-74 years) with urolithiasis underwent endoscopic lithotripsy with the Swiss Lithoclast under general anesthesia. The 0.8 = mm probe was inserted through the deflected working channel (3.4F) of the Micro-6L ureteroscope (tip diameter 6.9F). The calculi were in the distal (N = 96; 67.1%), mid (N = 34; 23.8%), and proximal part (N = 13; 9.1%) of the ureter. The mean stone size was 6.8 mm (range 5-26 mm). Of the 137 patients whose stones we could access adequately, 70 (51.1%) were stone free immediately after the procedure, and another 31 (22.6%) had residual fragments <3 mm that passed spontaneously. The remaining 36 patients underwent another 50 procedures; 30 SWL sessions in 26 patients (19%), 17 further endoscopic lithotripsies in 14 (10.2%), and open surgery in 3. Application of the Swiss Lithoclast through semirigid miniureteroscopes is highly effective for endoscopic lithotripsy, regardless of stone composition. Deflection of the probe up to 30 degrees did not impair the disintegration rate. Because of the high migration rate of mid and proximal ureteral stones, the Swiss Lithoclast is not recommended in these cases as a primary procedure. Low capital cost and simple and safe handling are the device's major advantages over laser lithotripsy.
尽管体外冲击波碎石术（SWL）是治疗输尿管结石的一种成功方法，但微型输尿管镜的引入推动了内镜治疗的发展。我们将半硬性输尿管镜与气动碎石机（瑞士碎石机）联合使用来治疗输尿管结石。1992年1月至1994年8月，143例尿石症患者（男性87例，女性56例；平均年龄48.7岁；年龄范围22 - 74岁）在全身麻醉下使用瑞士碎石机进行内镜碎石术。通过Micro - 6L输尿管镜（尖端直径6.9F）的可偏转工作通道（3.4F）插入0.8毫米的探头。结石位于输尿管远端（96例；67.1%）、中段（34例；23.8%）和近端（13例；9.1%）。结石平均大小为6.8毫米（范围5 - 26毫米）。在137例结石能被充分处理的患者中，70例（51.1%）术后即刻结石清除，另外31例（22.6%）有残留碎片<3毫米且自行排出。其余36例患者又接受了50次治疗；26例患者（19%）进行了30次SWL治疗，14例（10.2%）进行了17次进一步的内镜碎石术，3例进行了开放手术。通过半硬性微型输尿管镜应用瑞士碎石机进行内镜碎石术非常有效，无论结石成分如何。探头偏转达30度并不影响碎石率。由于输尿管中段和近端结石的移位率高，不建议在这些病例中将瑞士碎石机作为首选方法。与激光碎石术相比，该设备的主要优点是成本低、操作简单且安全。
