输尿管软镜钬激光碎石术治疗输尿管上段结石

Flexible ureteroscopic Ho:YAG laser lithotripsy in treating upper ureteral stones

目的总结输尿管软镜结合钬激光治疗输尿管上段结石的疗效及并发症,探讨手术技巧。方法 38例输尿管上段结石患者接受输尿管软镜钬激光碎石治疗,先使用8/9.8F输尿管硬镜探查患侧输尿管,置入导丝后留置输尿管软镜鞘,引入输尿管软镜,钬激光碎石,并使用套石篮套取出较大的结石碎屑。结果 35例患者一期顺利碎石,3例因输尿管狭窄难以置入输尿管软镜鞘,留置输尿管内支架2周后再次手术成功。手术时间31～56min,平均42min。术后7例患者发热,无其他严重并发症。术后1个月拔除内支架,2周后复查KUB,结石清除率92.1%。结论输尿管软镜结合钬激光是处理输尿管上段结石的有效手段,即便输尿管结石进入肾内,也可一期处理,避免了额外的体外碎石操作。

Objective To summarize and evaluate the efficacy of flexible ureteroscopic Ho：YAG laser lithotripsy for the treatment of upper ureteral stone, and investigate the surgery skills. Methods Thirty-eight cases with upper ureteral stone received flexible ureteroscopic Ho： YAG laser lithotripsy. After a guidewire was indwelled with 8/9.8 F rigid ureterosope, the ureteric sheath for flexible ureter was inserted to the target ureter, then flexible ureteroscopy was done, stone was fragmented by Ho：YAG laser, and re- moved by basket. Results Thirty-five patients were treated successfully in one session, 3 patients received repeated ureteroscopy 2 weeks later since ureter structure in the first session. Operation time ranged from 31 to 56 minutes, mean time was 42 minutes. Postoperative fever was noted in 7 cases, no other severe complication was noted. Ureter stent was removed 1 month postoperativly, and the stone clearance rate was 92.1% two weeks later. Conclusions The flexible ureteroscopic Ho：YAG laser lithoripsy was a safe and effective way to treat upper ureteral stones, even though stones back to renal collecting system sometimes, ESWL was not needed.