Ureteroscopic treatment of ureteral calculi in 1285 casesWang Yuliang, Wenling Hospital of traditional Chinese medicine, Chen Shifu,, and he
Ureteroscopic treatment of ureteral calculi in 1285 cases
Wang Yuliang, Wenling Hospital of traditional Chinese medicine, Chen Shifu,, and he accounted for the practice of the double - and - to - do - on - the - spot of the two - and - the -
Zhejiang Wenling 317500
[Abstract] Objective: To summarize the experience of ureteroscopy in the treatment of ureteral calculi. Methods: from May 2004 to December 2010, 1285 cases of upper, middle and lower ureteral calculi were treated with ureteroscopic dual frequency laser or pneumatic ballistic lithotripsy. Results: the one-time success rate of lithotripsy was 93.6% (1203/1285), and the ureter was broken in the kidney in 1 cases, in the open surgery in 22 cases, in the difficult position of the mirror, and only in the double J tube in 49 cases, and the slide in the kidney in the calculus in 10 cases. No renal rupture. After 2-4 weeks, the rejection rate was 98.3%. Conclusion: the treatment of ureteral calculi with double frequency laser or pneumatic lithotripsy under ureteroscope is effective and safe.
Key words: ureteroscopy, dual frequency laser, pneumatic lithotripsy, ureteral calculi
Chinese Classification Number: R693.4
Our hospital since 2004 in the beginning of the use of double frequency laser lithotripsy under ureteroscope and pneumatic lithotripsy for treatment of ureteral stones, to obtain satisfactory results, summarized as follows:
1 materials and methods
1.1 clinical data
The group of 1285 patients, aged 21-82 years old, average 40 years old, male 759 cases, female 526 cases of upper ureteral calculi in 171 cases, 211 cases of middle and lower segment in 903 cases (70%), the recent implementation of extracorporeal shock wave lithotripsy in 97 cases and had 23 cases with ureterolithotomy, stone size ranging from 0.6-2.2cm. The average of 1.0cm. All patients were examined by ultrasonography or CT examination before operation, check the urine sediment, obviously controlled by the proper use of antibiotics for urinary tract infection.
Patients with lumbar anesthesia or epidural anesthesia, lithotomy position, F12 catheter, inserted under ureteroscope under the surveillance of F8, find the ipsilateral ureteral orifice, insert the guide wire for guidance, water injection, water pressure control in 150mm Hg, injection rate 50-80ml per minute, and then rushed into the ureter ureteral orifice, mirror, edge to observe and slowly push, until you find the stone, the stone in the head of the laser fiber surface contact, set the pulse energy 120mJ, pulse frequency is 5-10Hz to be single or pneumatic ballistic lithotripsy, set fire, gravel bar pressed stones were crushed during operation according to the degree of clarity of vision, control pressure flow to prevent stone drift, and use forceps remove the stone slightly, crushed stones to each end of 2.0mm, no abnormal ureter exploration, pull out the ureteroscope. Along the guide wire into the double J tube in the affected side of the ureter, a head placed in the renal pelvis, a head placed in the bladder, the withdrawal of the guide wire, leaving the catheter, routine antibacterial for several days. 2-4 weeks after the review of B ultrasound or abdominal plain film, to be discharged after the stone, you can double J tube.
Author: Department of Urology, Wenling Hospital of traditional Chinese medicine, Wang Yuliang
1285 cases of a successful lithotripsy in 1203 cases, to carry out the operation of 1 patients with early operation due to long time improper operation caused by ureteral rupture, leading to renal resection, not rotten after placing double J tube to open ureterolithotomy directly in 22 cases of ureteral perforation or stenosis or ureteral orifice plug, 49 cases of ureteral stenosis or orifice can not be placed directly into the mirror guide wire, stone slide into the kidneys, 10 cases of upper ureteral calculi, no renal rupture in operation, stable vital signs of all the patients, no septic shock after the operation, the operation time of 10 minutes to 40 minutes, an average of 20 minutes, 2-7 day hospital, the average hospitalization days 4 day, 2-4 weeks later pull double J tube.
Double frequency laser lithotripsy, contact laser lithotripsy, laser into mechanical shock wave lithotripsy, almost no heat damage, Th0mas animal experiments show that laser fiber on rabbit bladder mucosa bombardment damage depth of not more than 0.1 mm, only caused mild congestive mucosa edema without muscle injury and perforation (1), pneumatic lithotripsy the principle is the gravel bar by the compressed air and the bullet striking before and after exercise, the impact of amplitude is less than 2mm, no heat, the ureteral mucosa with only minor injuries, so the two stones are safe and effective, the segment ureteral calculus is available.
Ureteral calculi basically is kidney stone row caused by may cause renal colic, hydronephrosis, renal function damage, ureteroscopic lithotripsy has become an alternative open method of stone, there are a lot of advantages compared with open surgery and postural lithotripsy of ureteral calculi, has been widely accepted by urologists, we summarize ureteroscopy under the double frequency laser lithotripsy in 1285 cases and the effective rate was 93.6%, complications and a renal resection was carried out early ureteroscopy, lack of experience, for too long time in the operation of upper ureteral calculi, ureteral perforation did not tear open, after a week due to obvious pain of double J tube in abnormal position, open exploration of ureter torn beyond repair, finally the removal of the kidney. Changed to open surgery and 22 cases of intraoperative ureteral stenosis ureter stones or not to explore the insertion of indwelling double J tube in patients with difficult, requires a one-time stone removed converted to open surgery, serious ureteral perforation only two cases were converted to open. In order to avoid ureteral perforation or mucosal tear tear operation time is not too long, it is best not more than 30 minutes, light, to look into the mirror. Stone drift in the kidney are found in the upper ureteral calculi, early surgery or surgery skills easily lead to less skilled stone drift, according to paragraph three of ureter four points (2), that the upper calculus (that is, above the waist 4 intertransversarii ureteral stone) in the process of easy to drift into the kidney, using percutaneous nephrolithotomy the mirror is better, the upper, middle and lower ureter calculi with high success rate. Ureteroscopic lithotripsy causes renal rupture have been reported at home, we have not met, reduce flushing pressure and flushing speed, shorten the operation time may reduce renal rupture, if suffering from sudden intraoperative side obvious pain, urine red heart and kidney rupture should occur, such as the conversion to open surgery, simply placed double J tube parts to discharge the stone or a combination of ESWL operation, remove all stones. Because the ureteral polyp dual frequency laser and pneumatic ballistic can play a role in the soft tissue, and can not be removed, domestic reports of patients with ureteral calculi complicated with polyps, stone crushing, insertion of double J tube, without treatment of polyps, with stones disappear and fade polyp.
 Zhao Weisun Yong Tao. Mechanism analysis of pulsed laser plasma shock wave lithotripsy 131-133. Acta Sinica.1998.27.11
 Xia Shujie. Minimally invasive surgery of Department of Urology, Shandong science and Technology Press, 2006.7. 99-135.
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