经尿道输尿管肾镜钬激光碎石术治疗上尿路结石

Ureteropyeloscopic lithotripsy with holmium:YAG laser for treatment of ureteral calculi

目的探讨经输尿管肾镜联合钬激光腔内治疗输尿管结石的有效性及安全性。方法分析2005年1月-2006年12月收治的经输尿管肾镜钬激光治疗输尿管结石206例的临床资料。其中181例伴有患侧轻、中度肾盂积水,IVP患肾不显影19例,28例同时合并结石远端输尿管狭窄,57例合并有息肉或肉芽组织包裹,26例为体外冲击波碎石术(ESWL)治疗失败。结果206例中195例单次手术碎石成功,单次手术结石粉碎率达94.7%(195/206)。平均手术时间25 min,术中无输尿管穿孔等并发症发生,平均住院日5.5 d。10例结石在钬激光碎石过程中移位于肾盏或结石残留,术后再行ESWL治愈;1例双侧输尿管结石,因输尿管狭窄无法入镜,中转开放手术。结论输尿管肾镜联合钬激光碎石术治疗输尿管结石有效、安全,可作为输尿管结石特别是中下段结石首选的治疗方法。

To evaluate the efficacy and safety of ureteropyeloscopic lithotripsy with holmium.YAG laser on the endoscopic treatment of ureteral calculi. Methods Investigated the clinical material on Holmium laser endoscopic treatment of 206 cases with ureteral complicated calculi form Jan. 2005 to Dec. 2006. Among them,181 cases have hydronephrosis,28 cases of ureteral stricture,57 cases of polypus and 26 cases of fail after ESWL. Results The overall rate of successful fragmentation for all levels of ureteral stones in a single procedure achieved 94.7% （195/206）. The mean operative time was 25 min, and the mean postoperative hospital stay was 5.5 days. Ten cases experienced failure because of stone shift or residual in the operation, they were treated by ESWL. One case experienced open operation because of ureteral stricture. Conclusion Ureteropyeloscopy and holmium.YAG laser lithotripsy is a highly effective and safe therapy for patients with ureteral calculi. It can be considered as a first choice of treatment, especially for those with middle or lower levels of ureteral stones.