经输尿管镜钬激光碎石治疗输尿管结石

Holmium laser lithotripsy under ureteroscope for ureteral calculi

目的探讨经输尿管镜钬激光碎石治疗输尿管结石的临床效果。方法90例输尿管结石,经尿道、膀胱置入10°输尿管镜抵达结石处,将光纤头直抵结石,设置工作能量0.8～1.5J,频率8～10Hz,采用连续脉冲方式粉碎结石。结果3例进镜失败(输尿管镜无法到达结石部位)改开放手术,1例输尿管穿孔改开放手术;86例碎石成功,单次钬激光碎石成功率为95.6%(86/90)。手术时间30～80min,平均55min。术后住院1～5d,平均2.5d。86例随访1～3个月,69例病程<6个月、肾积水<4cm,肾积水完全消失;17例病程>6个月、肾积水>4cm,术后患肾均有不同程度积水,但较术前明显改善。结论经输尿管镜钬激光碎石治疗输尿管结石效果理想,创伤小,并发症少,可作为输尿管中、下段结石的首选治疗方法。

Objective To evaluate the clinical results of holmium laser lithotripsy under ureteroscope for the treatment of ureteral calculi. Methods A total of 90 cases of ureteral calculi were includecl in the study.A 10° ureteroscope was advanced through the urethra and bladder with its tip touching the stone. Holmium laser pulse radiation with a pulse energy of 0.8~1.5 J and repetition rates of 8~10 Hz was focused into the stones. Results Conversions to open surgery were required in 4 cases because of failed ureteroscope insertion (3 cases) or ureteral perforation (1 case). Holmium laser lithotripsy was successfully completed on one session in 86 cases, the success rate being 95.6% (86/90). The operation time was 30~80 min (mean, 55 min), and the postoperative hospital stay, 1~5 d (mean, 2.5 d). A follow-up was conducted for 1~3 months in the 86 cases. Of 69 cases with duration of disease <6 months and hydronephrosis <4 cm, the hydronephrosis entirely disappeared; of 17 cases with duration of disease >6 months and hydronephrosis >4 cm, the hydronephrosis significantly subsided. Conclusions Holmium laser lithotripsy under ureteroscope for ureteral calculi was effective, mini-invasive, The procedure can be considered as the first choice for mid-lower ureteral calculi.