腔内钬激光治疗上尿路疾病101例报告

Holmium Laser for the Treatment of Upper Urinary Tract Diseases:Report of 101 Cases

目的探讨腔内钬激光治疗上尿路疾病的疗效。方法输尿管狭窄及中下段输尿管结石经尿道置入输尿管镜应用钬激光治疗;上段输尿管结石及肾结石建立经皮肾取石通道,然后置入输尿管镜应用钬激光碎石。结果无输尿管穿孔、漏尿及感染等情况发生。23例输尿管狭窄中,6例狭窄段消失,10例较治疗前增宽;5例输尿管狭窄段无明显增宽;2例输尿管狭窄段无变化或较治疗前狭窄加重或肾积水,输尿管扩张无变化,患者仍有腰部胀痛及反复感染症状,转开放性手术,行输尿管狭窄段切除,端端吻合术后治愈。术后随访3～24个月,平均12个月,无再狭窄。40例中下段输尿管结石中,采用输尿管镜逆行碎石,33例结石粉碎成功,7例结石返回肾脏,经二期体外震波碎石治愈;术后随访3～18个月,平均15个月,无输尿管狭窄、再发结石。24例上段输尿管结石及14例肾结石中,采用经皮输尿管镜碎石术,一期结石取净36例,2例由于术中出血,视野不清,留置肾造瘘管1周后二期将结石取净;术后随访3～24个月,平均18个月,无结石残留、再发、输尿管狭窄等。结论腔内钬激光治疗上尿路疾病是安全、微创,疗效显著,并发症少,值得推广应用。

Objective To investigate the efficacy of Holmium laser for upper urinary tract diseases. Methods A total of 101 patients with urinary tract stricture or calculus in the lower or middle ureter were treated with holmium laser by ureteroscopy from January 2005 to June 2007 in our hospital. For the patients with stones in the upper urinary tract or the kidney, percutaneous nephrolithotripsy （PNL） with holmium laser by ureteroscopy was performed. Results No patients developed perforation, urinary leakage, or infection after the operation. In the 23 cases of ureteral stricture, 6 were cured, 10 were improved, 5 were failed, and 2 were deteriorated or even developed hydronephrosis. The two who were deteriorated after the operation was converted to open surgery because of pain in the kidney area and refractory infection. They were cured after resection of the strictured segment and end-to-end anastomosis. Follow-up was available for 3 to 24 months （mean, 12 months） ; none of the patients had recurrence during the period. In the 40 patients with lower or middle ureteral stones, nephrolithotripsy was completed successfully in all but 7, in whom the stones moved into the kidney during the procedure. These 7 patients were then cured by extracorporeal shock wave lithotripsy. The 40 patients were followed up for 3 to 18 months （mean, 15） , none of them had recurrence. In the 24 cases of upper urinary tract stones and 14 patients with renal calculus, the stones were removed completely by the first PNL in 36; 2 patients received a second operation after indwelling renal cannula for 1 week because of intraoperative hemorrhage. These 38 patients achieved a follow-up of 3 to 24 months （mean, 18） , no one of them showed residual stones, or recurrent calculus or stricture of the ureter. Conclusions Holmium laser by ureteroscopy is safe, effective, and minimally invasive for patients with upper urinary tract disorders. The treatment is worth being used thanks to a low rate of intra-and postoperative complications.