双频双脉冲激光治疗尿路结石

Frequency doubled-double pulse laser lithotripsy in the treatment of urinary tract calculi

目的探讨双频双脉冲激光治疗上尿路结石的效果。方法总结 5 0 0例输尿管镜下双频双脉冲激光碎石经验。结果输尿管结石 4 70例中 ,一次碎石成功 4 33例 (92 .1% ) ,其中输尿管上段 14 8例中 ,一次碎石成功 12 6例 (85 .1% )。中下段 311例及多发结石 11例一次成功碎石 30 7例 (95 .3% )。上段碎石失败 2 2例中 ,结石上移和碎石不完全、结石过大 11例 ,二期行ESWL治疗。改开放手术 6例。术中输尿管穿孔 5例。中下段失败 15例 ,改开放手术 6例。碎石不完全 9例。后尿道膀胱结石 30例 ,2 9例碎石成功 ,1例改开放手术取石。全部病例术后都出现轻重不等的肉眼血尿。无发热 ,脓肾病例。平均手术时间 32min ,平均激光工作时间 3.3min。术后平均住院 2 .5d。结论双频双脉冲激光是一种功能单一、操作简单、安全、对软组织损伤小且碎石高效的激光 ,可作为腔镜下碎石的首选辅助工具。

Objective The efficiency of the frequency-doubled-double pulse Nd: YAG (FREDDY) laser, a new type of Neodymium: YAG laser, in the treatment of urinary tract calculi was studied. Methods 500 cases with urinary tract calculi treated with FREDDY laser U100 litrotripsy were summarized. Results Among 470 cases of ureteral calculi, 433 (92.1%) were successfully fragmented on their first laser lithotripsy. The successful rate for the first lithotripsy of the upper ureteral calculi(once successful) was 85.1% (126/148); the mid/lower (311) and multiple (11) ureteral calculi was 95.3% (307/322). Among 22 upper ureteral calculi cases with unsuccessfully fragmented calculi, 11 cases were due to the up drifting of the calculi or the incomplete lithotripsy (the size of the calculi too big), then ESWL treatments were performed. The open surgeries were performed in 6 cases, another 5 cases were because of perforation of ureter during the lithotripsy. Among 15 unsuccessfully fragmented cases with mid-lower ureteral calculi, the open surgeries were performed in 6 cases, 9 cases were the incomplete lithotripsy. Among 30 post urethra/bladder calculi, the calculi were successfully fragmented in 29 cases, and open surgery was performed in 1 case. Hematuria occurred in variant extent in every case after treatment. Neither fever nor pyonephrosis occurred after laser lithotripsy. The average procedure time was 32 minutes; the average laser working time was 3.3 minutes and the average hospitalization days after the operation were 2.5 days. Conclusion The FREDDY laser is a kind of laser with single function, easy manoeuvre slight safety, damage to the soft tissue and high efficiency for the lithotripsy. It can be the first choice in the treatment of urinary tract calculi.