经输尿管镜钬激光碎石术治疗输尿管结石

Clinical analysis of ureter calculi treated with ureteroscopic Holmium laser lithotripsy in 158 patients

目的总结经输尿管镜下钬激光碎石术治疗输尿管结石的临床经验。方法105例(111侧)输尿管结石行经输尿管钬激光碎石术治疗。结石直径0．6～2．4cm,平均(1．3±0．4)cm,结石合并息肉12侧。分析钬激光碎石术碎石时间、结石粉碎率、住院时间、并发症发生率等指标。结果105例(111侧)输尿管结石一次手术结石粉碎率92．79%(103/111),其中下段结石97．77%(44/45),中段结石95．00%(13/14),上段结石80．77%(21/26);结石排净时间3～60d,平均(18．5±12．5)d,手术时间10～90min,平均(30．4±12．5)min,术后住院时间1～7d,平均(3．1±1．7)d。一次碎石不成功8例中,下段1例为输尿管开口狭窄无法置入输尿管镜而改行开放手术,中段2例为输尿管息肉部位出血视野不清,给予消炎止血治疗3d后二次碎石成功,上段5例失败者其中2例为输尿管严重扭曲而改行开放手术,另外3例均为结石移位入肾内,留置双J管后行ESWL治疗。术后高热5例,予以抗生素治疗3～7d后治愈。无穿孔、狭窄并发症。结论经输尿管镜钬激光碎石术具有高效、安全、微创、并发症少等优点。输尿管狭窄、扭曲、术中出现结石移位是影响手术结果的重要因素。

Objective To summarize tile clinical treatment experience of ureter calculi with ureteroseopic Holmium laser lithotripsy. Methods The Holmium laser with ureteroscopic techniques was performed on 105 patients （lllsides）with ureter calculi,and 12 patients with polypus at the same time. The average diameter of stone was 1.3±0.4cm （0.6-2.4cm）. Data on the operating time, stone-fragmented rate, hospitalization time aud complications rate were retrospectively analyzed.Results The direct success rates after the first operation which meant stone-free ureters in the lower, middle and upper ureters were 97.77%（44/45）, 95.00%（13/14） and 80.77%（21/26）, respectively, and the mean stone-free rate was 92.79%（103/111）. The average stone-free time, operating lime and hospitalization time were 18.5±12.5d （3-60d）,30.4±12.5min（10-90min）and 3.1±1.7d（1-7d）,respectively. Of all the 8 cases failed to success, 1 ease of lower ureter stone had to subjected to open operation because of ureter placket being straitness and unable to insert ureteroseopy,and 2 cases of middle ureter stone concomitant with ureter bleeding were fragmented on the second operation after hemostasis therapy for 3 days, and 2 cases of upper ureter stone were had to subjected to open operation because of ureter contortion, and the other 3 cases of upper ureter stone were received ESWL because of stone transferring to kidney.A febrile pyelonephritis occurred as a postoperative complication in 5 patients. Perforation and ureter obstruction did not occur. Conclusion The Holmium laser treatment of ureter calculi by ureteroseopy is an effective and safe technique, and has the advantages as minimally invasion and low incidence of complication. Ureter straitness,contortion and stone transferring are of important factors influencing on operation outcome.