钬激光微创经皮肾取石术治疗输尿管上段结石

Minimally invasive percutaneous nephrolithotomy with holmium laser for upper ureterolithiasis

目的探讨微创经皮肾顺行输尿管镜(minimallyinvasiveprecutaneousnephrolithotomy,MPCNL)钬激光碎石术治疗输尿管上段结石的疗效。方法B超定位下肾盂穿刺、扩张建立皮肾通道,应用输尿管硬镜于直视下采用钬激光碎石,共治疗输尿管上段结石228侧(203例)。结果一期碎石率95.2%,结石清除率显著高于经尿道输尿管镜碎石术。结论MPCNL结合钬激光碎石术治疗输尿管上段结石具有微创、安全、结石一次清除率高、可同期处理腔内病变及并发症少的优点,在具备设备条件及技术基础的单位可作为输尿管上段结石的首选治疗方法。

To describe our technique and clinical experience with application of antegrade minimally invasive percutaneous nephrolithotomy(MPCNL) and Holmium: YAG laser for the treatment of upper ureterolithiasis. 223 cases of upper ureterolithiasis were punctured by the guidance of B type ultrasonography, and successfully approached by tract dilation. Holmium: YAG laser was applied in the procedure. The simultaneous stone-free rate on discharge was 95.2%, much higher than that of retrograde transurethral ureterolithotomy. [Conclusions] MPCNL with Holmium laser is advantageous as it causes minimal renal injury, relatively safe, maximizes stone clearance, especially in patients with complex stone disease. It should be recommended as the first-line procedure for upper ureterolithiasis based on adequet experience and facilities.