钬激光治疗口服阿司匹林患者的输尿管结石的疗效分析

Clinical analysis of rigid ureteroscopy and holmium laser lithotripsy for managing ureteral calculi with anticoagulation by taking aspirin

目的探讨输尿管硬镜联合钬激光治疗口服阿司匹林抗凝的输尿管结石患者的安全性和有效性。方法2006年5月至2008年12月，我们使用输尿管硬镜联合钬激光治疗需长期口服阿司匹林抗凝同时罹患输尿管结石的患者33例，其中输尿管上段结石14例，下段结石19例。结果30例1次碎石成功，成功率为90．9％，3例结石回缩至。肾盂内，改行ESWL。无一例因术中出血导致视野不清而不得不提前终止手术。5例患者曾出现短暂肉眼血尿，所有患者均随访1～3个月，血红蛋白均无明显下降。结论对于需长期口服阿司匹林抗凝同时罹患输尿管结石的患者，使用输尿管硬镜联合钬激光碎石无需特殊术前准备及术后处理，安全有效。

Objective To evaluate the efficacy and safety in patients with ureteral calculi and anticoagulation by taking aspirin who underwent rigid ureteroscopy and Holmium laser lithotripsy. Methods 33 patients with anticoagulation by taking aspirin underwent rigid ureteroscopy lithotripsy for ureteral calculi at our institution from May 2006 to December 2008. Among them,14 cases were proximal ureteral calculi,19 cases were distal ureteral calculi. Results The overall stone-free rate was 90.9% and all except 3 were completed successfully in a sigle procedure,which needed to be performed with ESWL later. No procedure had to be terminated in the anticoagulation group due to poor visibility from bleeding. All patients were followed up for 1-3 months, none of their postoperative hemoglobin significantly declined though 5 of them underwent hemorrhagic urine briefly. Conclusions When necessary, rigid ureteroscopy and Holmium laser lithotripsy can be performed safely and efficaciously for ureteral calculi in patients on anticoagulation therapy without the need for perioperative manipulation.