输尿管软镜下钬激光碎石术治疗肾结石(附106例报告)

Ho∶YAG Laser Lithotripter through Flexible Ureteroscope for the Treatment of Renal Calculi:Report of 56 Cases

目的探讨输尿管软镜下钬激光碎石术治疗肾结石的疗效。方法采用输尿管软镜下钬激光碎石术治疗肾结石106例,结石大小0.8～1.6cm,平均1.2cm。经输尿管硬镜扩张后留置输尿管扩张鞘,寻及结石以200μm光纤、0.8～1.2J/5～10Hz功率钬激光碎石。结果106例共有结石122枚,结石寻及率96.7%(118/122),单次碎石成功率91.8%(112/122)。手术时间30～60min,平均45min。术后住院1～4d,平均3d。无脓肾、输尿管穿孔等并发症。91例随访3～12个月,平均6个月,无结石复发。结论输尿管软镜下钬激光碎石术治疗肾结石安全、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震波碎石效果不佳的患者,疗效确切,并发症少。

Objective To evaluate the clinical effect of Ho∶YAG laser with flexible ureteroscope on the patients with renal calculi. Methods Totally 106 patients with renal stones were treated by Ho∶YAG laser using flexible ureteroscope in our hospital. The diameter of the stones ranged from 0.8 to 1.6 cm with a mean of 1.2 cm. After dilation of the ureter, the stones were fragmentize and removed by using 200-μm Ho∶YAG laser fiber （0.8-1.2 J/5-10 Hz）. Results The 106 patients had totally 122 stones, 118 of them were detected （96.7%）. The success rate of stone fragmentation after one session was 91.8% （112/122）. The operation time ranged from 30 to 60 min with a mean of 45 min. The patients were discharged from hospital in 1-4 days （mean, 3 days） after the operation. No ureteral perforations or pyonephrosis occurred in this series. The 91 patients were followed up for 3-12 months（mean,6 months）, during which no recurrence was found. Conclusion Ho∶YAG laser lithotripsy through flexible ureteroscope is a safe and effective treatment for calyceal calculi, especially for patients with unfavorable anatomic factors related to ESWL and those with minor stones and without significant hydronephrosis.