提高输尿管镜钬激光治疗输尿管上段结石成功率的体会

The Experiences of Elevating the Successful Rate on Treating Upper Ureter Stones by Ureteroscope and Ho:YAG Laser

目的:总结输尿管镜钬激光治疗输尿管上段结石时减少碎石上移和提高碎石成功率的体会。方法:用输尿管镜钬激光治疗输尿管上段结石71例,对其中35例第4腰椎横突以上结石碎石前预置金属或N-Trap网篮,对15例反流入肾盂>0.4cm碎石辅以输尿管软镜钬激光碎石。结果:输尿管穿孔1例;原位残留碎石1例;15例>0.4 cm碎石被冲入肾盂,用输尿管软镜钬激光辅助肾盂内碎石;失败3例。本组输尿管镜钬激光治疗输尿管上段结石一次碎石成功65/71(91.6%)。结论:在输尿管镜钬激光碎输尿管上段结石中,预置金属或N-Trap网篮可以减少碎石反流入肾盂机会,对已反流入肾盂的碎石结合输尿管软镜钬激光治疗,可以提高输尿管镜钬激光治疗输尿管上段结石的一次碎石成功率。

Objective：To summarize the experiences of decreasing stone fragments upward moving and increasing the successful rate of lithotripsy on treating upper ureter stones by ureteroscope and Ho：YAG laser. Methods： A total of 71 cases of upper ureter stones were treated with ureteroscope and Ho： YAG laser. 35 cases had their stones positioned above 4th lumbar vertebra transverse were left metal or N-Trap basket before procedure. 15 cases with fragments larger than 0. 4 cm refluxed into pelvis were assisted with flexible ureteroscope and laser. Resuits：l case happened ureter perforation, 1 case had residual fragment in situ, 15 cases had their stones refluxed into pelvis that were then treated with flexible ureteroscope and laser, 3 cases failed. The once successful cases in this group were 65/71 （91.6%）. Conclusions：In treating the upper ureter stones by ureteroscope and Ho ： YAG, left metal or N-Trap basket before the procedure could decrease the opportunity of fragments refluxed into the pelvis. Using flexible ureteroscope and Ho ： YAG laser to treat patients that had their fragments refluxed into the pelvis could increase the stone clearance rate of ureteroscope lithotripsy.