钬激光与U100激光治疗上尿路结石疗效的比较研究

Comparison of Holmium Laser and U100 Frequency-doubled-double Pulse Nd:YAG Laser Lithotripsy for Upper Urinary Calculi

目的比较输尿管镜下钬激光与U100激光治疗上尿路结石的疗效。方法2010年6月～2012年11月280例。肾和输尿管结石分别行输尿管镜下钬激光碎石（钬激光组，n=188）或U100激光碎石（U100激光组，n=92），比较2种激光的疗效。结果一次碎石成功率钬激光组98．4％（185／188），显著高于U100组80．4％（74／92）（x2=28．751，P=0．000）；钬激光组碎石直径（1．30±0．10）mm，显著大于U100激光组（0．92±0．06）mm（t=33．591，P=0．000）；钬激光组激光工作时间（7．5±2．3）min，明显长于U100激光组（6．5±1．9）min（t=3．610，P=0．000）。钬激光组3例结石部分上移至肾盏，软镜无法探及，改行ESWL；合并息肉（息肉〈2cm）36例，术中行钬激光息肉电灼术；合并结石远端轻度狭窄9例，行钬激光内切开扩张成形；并发输尿管穿孔3例，留置双J管4周后愈合；1例术后6个月出现严重输尿管壁纤维化狭窄致肾盂积水，行开放狭窄段切除、输尿管端端吻合。U100激光组结石≤10mm碎石成功率94．1％（32／34），结石〉10mm者72．4％（42／58）。14例因U100无法粉碎结石而失败，其中10例改行钬激光碎石，4例行ESWL；4例结石部分上移至肾下盏，无法探及二期行ESWL。结论钬激光碎石一次成功率高，可同时处理息肉和狭窄等输尿管合并症；U100激光对10mm以下结石成功率高，碎石直径小，可提高净石率，术后并发症少；2种激光的合理选择可显著提高碎石疗效。

Objective To compare the efficacy of Holmium laser and U100 Frequency-doubled-double pulse Nd： YAG laser （ U100 laser） lithotripsy for upper urinary calculi. Methods The clinical data of 280 cases of renal and ureteral calculi undergoing Holmium laser lithotripsy or U100 laser lithotripsy from June 2010 to November 2012 were retrospectively analyzed. Among the 280 cases, 188 received Holmium laser lithotripsy and 92 received U100 laser lithotripsy. The effect of the two procedures were compared. Results The success rate of stone breaking in single procedure in the Holmium group was 98.4% （ 185/188 ） , significantly higher than that of the UIO0 group [ 80.4% （74/92） , X2 = 28.751, P = 0. 000 ] ; the diameter of residual stone in the Holmium group was （1.30±0.10） mm, significantly bigger than that of the U100 group [（0.92 ±0.06） ram, t =33.591, P =0.0001]; the laser working time in the Holmium group was （7.5 ± 2.3） min, significantly longer than that of the U 100 group [ （6.5 ± 1.9） min, t = 3. 610, P = 0. 0001. In the Holmium group, calculi in 3 cases drifted into kidney calices and failed to be reached by flexible urcterscope and converted to ESWL; 36 eases were complicated with polyp of ureter （ smaller than 2 era） and underwent polypectomy; 9 cases were complicated with mild stenosis of distal ureter and accepted resection of the strictured segment by Holmium laser; 3 cases suffered from ureteral perforation and were cured by indwelling double-J for four weeks; 1 case suffered from serious fibrotic stenosis leading to severe hydronephrosis 6 months after the surgery and was treated by resection of the strictured segment and end to end anastomosis of ureter. In the U100 group, the success rate of stone breaking was 94.1% （32/34） for calculi of smaller than 10 mm and 72.4% （42/58） for calculi of bigger than 10 mm; lithotripsy failed in 14 cases, so 10 cases were converted to Holmium laser and 4 to EWSL; calculi drifted into kidney ealices in 4 cases, and failed to be reached by flexible ureterscope and converted to ESWL. Conclusions Holmium laser lithotripsy has higher success rate of stone breaking in single procedure, and polyp and stenosis of ureter can be dealt with during the procedure. U100 laser lithotripsy has higher success rate for residual stones of smaller than 10 mm, higher stone clearance rate and less complications. Proper choice of the two lasers can significantly improve the effect of lithotripsy.