目的 探讨输尿管硬镜下气压弹道碎石术或钬激光碎石术治疗输尿管结石失败的原因和处理措施.方法 回顾性分析39例输尿管结石经输尿管镜下气压弹道碎石术或钬激光碎石术治疗失败患者的临床资料.结果 本组39例输尿管硬镜下治疗输尿管结石失败患者,根据不同病因采用相应方法处理,术后经门诊及电话随访3周～2个月,碎石、排石效果良好,获得治愈,均无严重并发症.结论 结石上移肾盂、输尿管扭曲、输尿管狭窄、输尿管开口异常、术中出现并发症是输尿管镜下气压弹道碎石失败的常见原因,熟练的技术操作及冲洗速度的及时调整可以提高手术成功率、减少并发症.手术失败后应根据情况改行体外冲击波碎石(ESWL)、微创经皮肾穿刺肾镜下钬激光碎石术(M-PCNL)或开放手术.%Objective To investigate the causes and management of failed treatment of urethral calculi using hard microscopic pneumatic lithotripsy or holmium laser lithotripsy. Methods Retrospective analysis of clinical data from 39 urethral calculi patients suffered failed treatment of ureteral calculi by urethral microscopic pneumatic lithotripsy or holmium laser lithotripsy. Results All the 39 cases suffered failed urethral hard microscopic treatment for ureteral calculi were managed according to different causes, and then followed - up for 3 weeks - 2 months. Effects of lithotripsy were satisfying and all patients recovered with no serious complications. Conclusion Calculus upward displacement to pelvis, distortion, urethral stricture, urethral o-pening abnormalities and intraoperative complications are common causes for failures of urethral microscopic pneumatic lithotripsy. Better operation techniques and flushing speed adjustment can improve the success rate and reduce the complications. For failed surgeries, extracorporeal shock wave lithotripsy ( ESWL ), minimally invasive percutaneous nephrolithotomy ( M - PCNL ) or open surgery might be considered according to the specific conditions.
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