钬激光腔内碎石治疗尿道膀胱结石53例疗效分析

Endoluminal holmium laser lithotripsy for urethral and bladder calculi

目的探讨钬激光治疗尿道结石、膀胱结石的疗效及并发症。方法回顾性分析53例尿道结石、膀胱结石患者行钬激光腔内碎石治疗的临床资料。结果52例患者一次碎石成功（98．1％）；1例需再次行体外冲击波碎石治疗。48例用Ellic冲洗器直接冲洗出结石碎块；2例未完全冲洗出；3例儿童患者依靠自行排出。术后第1天行肾、输尿管及膀胱（KUB）检查：48例膀胱无阳性结石影；2例残留直径≤4mm结石。手术时间：膀胱结石平均（73±38）min；尿道结石平均（36±13）min。并发症：血尿（100％）、膀胱刺激症状（100％）、发热（7．5％）、膀胱黏膜损伤（28．3％）、电解质紊乱（1．9％）、结石残留（3．8％）、尿道或膀胱穿孔（0）。1个月后随访，3例儿童患者膀胱内结石已排出；另2例有残余结石患者尚有1例有结石，采用体外冲击波碎石治疗。结论钬激光器可安全有效地清除尿道结石、膀胱结石。

Objective To evaluate the clinical effect and complication of endoluminal holmium laser lithotripsy for treatment of urethral and bladder calculi. Methods A total of 53 cases of urethral or bladder calculi were reviewed. The patients were treated with LUMENIS POWER Suite 100W holmium laser lithotripsy under Circom cystoscope between March 2004 and December 2007. Results Fifty-two cases achieved stone-free at first time （98.1%）. The fragmented stones in 46 cases were washed out with Ellck douche. Stones in 3 children cases were removed the automatically. All patients received KUB at the first postoperative day. Results showed that 48 cases had no stone; 2 cases had residual stone with sizes less than 4 mm. Average operative time of bladder calculus was 73 ＋38 min and urethral calculus was 36 ± 13 min. Complications included hematuria（ 100% ） ,irritation sign of bladder（ 100% ）, fever （ 7.5% ）, injury of mucous membrane of urinary bladder （ 28.3% ）, electrolyte disturbances （1.9%） ,residual stone （3. 8% ）, urethra or blader perforation （0%）. One month follow-up after operation discovered 3 children cases were lithecboled. Meanwhile in the remaining 2 cases, .one still had stones and was treated with ESWL. Conclusion Urethral and bladder calculi can be removed by endoluminal holmium laser lithotripsy safely and effectively. The associated discomfort is mainly related with manipulation of endoscope.