输尿管软镜治疗微创经皮肾术后残余结石

Holmium Laser Lithotripsy with Flexible Ureteroscope for Retained Calculus by mPCNL

目的探讨输尿管软镜治疗微创经皮肾术后残余结石的疗效。方法采用输尿管软镜下钬激光碎石和取石钳取石术治疗微创经皮肾术后残余结石32例,结石大小0.4～1.2cm,平均0.8cm。经留置输尿管扩张鞘或沿导丝直接置入美国顺康F7.9输尿管软镜抵达肾盂,寻及结石后以200μm光纤、10W功率钬激光碎石或用软性输尿管钳取石。结果32例共有结石51枚,结石寻及率90.2%(46/51),单次碎石成功率80.4%(41/51),其中上、中盏结石12枚,结石寻及率100.0%,单次碎石成功率91.7%(11/12);下盏结石39枚,结石寻及率87.2%(34/39),单次碎石成功率76.9%(30/39)。无严重并发症发生。结论输尿管软镜治疗微创经皮肾术后残余结石安全、有效,尤其适用于结石体积较小、肾盏无明显积水,以及因解剖特点预期体外冲击波碎石效果不佳的患者。

Objective To explore the effect of holmium laser lithotripsy with flexible ureteroscrope for retained calculus by mPCNL. Methods There are 32 cases who were adopted holmium laser lithotripsy with flexible ureteroscope and ureter forceps for retained calculus by mPCNL. Lithogenous size is 0.4-1.2cm,average is 0.8cm. The flexible ureteroscrope reached pelvis through ureterectasia-scabbard or guide wire, the calculus removed were adopted holmium laser lithotripsy with flexible ureteroscrope which equiped with 200um optical fiber and 10W power or flexible ureter forceps. Results There were no serious complications occurred in 32 cases. There were 51 calculus, the rate of that we could find was 90.2%, 80.4% ones were achievement ratio which had been broken first. There were 12 ones in the supra- and？ recta-calyces,the rate of that we could find was 100% ,91.7% ones were achievement ratio which had been broken first.There were 39 ones in the infra-calyces, the rate of that we could find was 87.2%, 76.9% ones were achievement ratio which had been broken first. Conclusion Holmium laser lithotripsy with flexible ureteroscope for retained calculus by mPCNL is safe and effective,particularly applicable to smaller stones and there is no water in the calyceal, as well as the patients＇ effects expected of extracorporeal shock wave lithotripsy is poor because of anatomical characteristics.