钬激光在治疗输尿管结石中的应用

Application of Holmium Laser to Treatment of Ureteral Calculi

目的总结分析钬激光治疗输尿管结石的经验和教训，提高结石的治疗水平。方法本组患者189例，右侧输尿管结石108例，左输尿管结石72例，双侧输尿管结石9例。共进行手术196例次。193例采用连续硬膜外麻醉，3例采用全麻。患者取截石位，先经膀胱镜在同侧置入输尿管导管，在导管的引导下置入输尿管镜。找到结石，经输尿管镜置入钬激光光纤，对结石进行粉碎，如遇有黏膜包裹结石或有息肉形成时，可直接用钬激光清除黏膜或息肉后再进行碎石。治疗结束后置双J管，排石治疗，2—4周后复查，必要时再行体外碎石治疗。结果本组患者196例次，6例改开放，9例结石退入肾盂失败，2周后复查结石清除率为72％（130／181），1个月后复查结石消除率为89％（161／181），3个月后复查，结石清除率为98％（177／181）。4例未排净结石者行ESWL治愈。术后并发症：发热29例次（16％）；血尿161例（89％），无严重的肉眼血尿。5例术中出现穿孔，留置双J管后痊愈，本组患者最长随访2年，未出现远期并发症。结论经钬激光治疗输尿管结石效果好、并发症少，可反复应用。

Objective To evaluate the efficacy and limitation of holmium laser in the treatment of ureteral calculi. Methods We used holmium laser to treat ureteral calculi in 189 patients （including two patients with bilateral uretersl calculi） through ureterorenoscopy. Resulls The treatment was successful in 181 patients and the success ratio was 181/189 （95%）. The stones migrated into renal pelvis in 9 cases and were not be found in 6 cases. As for complications, ureteral perforation occurred in 5 patients. Hematuria were observed in 161 cases, and fever in 29 cases after the operation. Conclusion Holmium laser is effective and safe for ureteral calculi.