小切口联合输尿管镜钬激光碎石术治疗复杂性输尿管下段结石32例

Small margin with ureteroscope holmium laser lithotrity for complex lower ureter stones(a report of 32 cases)

目的探讨复杂性输尿管下段结石在内镜治疗失败后进一步治疗的有效方法。方法 2004年5月~2009年8月采用输尿管镜下钬激光碎石术治疗962例输尿管结石患者,其中,复杂性输尿管下段结石首次内镜治疗失败32例,改用小切口联合输尿管镜钬激光碎石术治疗。结果 32例患者均一次性清除结石,成功率为100%。无输尿管穿孔、出血及损伤周围其他脏器等并发症,术后复查B超及静脉尿路造影未发现结石残留。随访4~36月,无输尿管狭窄及结石再嵌顿发生,患肾积水明显改善。结论采用小切口联合输尿管镜钬激光碎石术,治疗嵌顿性炎性息肉包裹、重度输尿管管腔狭窄或输尿管开口畸形等复杂性输尿管下段结石,和常规开放手术治疗比较,具有损伤小、出血少、并发症少、恢复快等优点,临床效果满意,值得借鉴。

Objective To explore the effective therapy after holmium laser lithotrity for complex lower ureter stones.Methods From May 2004 to August,2009,holmium laser lithotrity was used to treat 962 ureterolithiasis cases,among which 32 cases failed and received small margin with ureteroscope holmium laser lithotrity.Results The 32 removed stanes compleacly after one session,with a success ratio of 100%.No ureter perforation,periphery hemorrhage or damage on other internal organs occurred.After the treatment,ultrasound examination and vein urine road radiography had not discovered remaining stones.During the follow-up of 4~36 months,no ureterostenosis or stone recurred and renal drepsy was significantly imperoved.Conclusion Small margin with ureteroscope holmium laser lithotrity for complex lower ureter stones had the adrantages of minimal invasion,less biecding,less complicationand faster recorery.