微创经皮肾镜双脉宽钬激光碎石术治疗上尿路结石

Treatment of upper urinary calculi with double frenquency Ho∶YAG laser lithotriptor by minimally invasive percutaneous nephrolithotomy

目的：探讨微创经皮肾镜双脉宽钬激光碎石术治疗上尿路结石的临床效果。方法：用钬激光技术通过微创经皮肾镜通道，对31例肾结石、12例输尿管上段结石患者实施治疗。结果：肾结石一期粉碎排净26例，5例残石者残石大小0．5～0．8cm，2例经药物排石、3例经体外碎石治疗于术后1个月排净。输尿管结石者均一期粉碎排净。其中1例合并息肉，9例局部肉芽组织形成，2例为肉芽组织包裹，均采用宽频行汽化、切割。结石一期粉碎排净率为92％（40／43）。患者术后均恢复顺利，无严重并发症发生。结论：微创经皮肾镜双脉宽钬激光碎石是治疗肾及输尿管上段结石的安全有效方法，尤其合并有肉芽和息肉形成者，具有创伤小、恢复快等优点。

Objective： To investigate the clinical outcomes of double frenquency Ho ： YAG laser lithotriptor with minimally invasive percutaneous nephrolithotomy in upper urinary calculi treatment. Methods：Totally 12 cases of patients with upper ureteral calculi and 31 cases of renal calculi patients were treated with Ho ： YAG laser lithotriptor by minimally invasive percutaneous nephrolithotomy. Results： All the upper ureteral calculi patients achieved stone-free at 1 session. And polypus（1 case）, granulation （9cases）, granulations wraped up（2 cases） were resected with wide frequency vaporization ablation. Of 31 cases with renal calculi 26 achieved stone free at 1 session. The remained stones ranged from 0. 5 to 0. 8 cm in 5 patients were expectorated in 1 month（2 cases treated by medicine and 3 cases treated by ESWEL）. The overall successful stone fragmentation rate with stone-free expectoration of the ureteral and renal calculi was 92% （40/43）. All the patients recovered well postoperatively and no major complications observed. Conclusions： The technique of double frenquency Ho ： YAG laser lithotriptor with minimally invasive percutaneous nephrolithotomy is safe and effective for the treatment of upper urinary calculi,especially accompanied with polypus and granulation, and has advantages of minimal trauma and easy recovery.