经输尿管镜钬激光碎石术治疗输尿管结石180例报告

目的探讨经输尿管镜钬激光碎石术治疗输尿管结石的安全性和有效性。方法回顾总结我院自2005年12月至2009年7月间，应用经输尿管镜钬激光碎石术治疗输尿管结石180例（其中男95例，女85例），输尿管上段结石45例，中下段结石135例，结石直径大小0．5—3．0cm，平均1．2cm。观察手术成功率、手术时间、术后住院时间、并发症等。结果单次碎石成功率95％（171／180），其中输尿管上段86．7％（39／45），中下段97．8％（132／135）。未成功的9例中，4例结石上移至肾盂，均为输尿管上段结石，5例因进镜失败中转开放手术。手术时间18—120min，平均43min，术后住院时间1—8d，平均3．5d。并发症发生率4．44％（8／180），其中输尿管穿孔4例，均为输尿管上段结石，术后持续高烧3例（其中1例同时出现持续血尿），术后并发肾绞痛并48h无尿1例。结论经输尿管镜钬激光碎石术治疗输尿管结石尤其是输尿管中下段结石安全可靠，具有疗效肯定、损伤小、住院时间短等优点。

Objective To Approach the safety and efficacy of ureteroscope holmium laser lithotripsy in the treatment of calculus of ureter. Methods Review summarize 180 patients of calculus of ureter who were un- derwent ureteroscope holmium laser lithotripsy from Dee 2005 to July 2009.95 males and 85 female patients. 45 patients suffered from calculus in the superior segment of ureter and the other 135 case suffered from calculus in the mid-inferior segment of ureter. The average size of the calculus was 1.2 etn（ 0. 5 -3 cm）. achievement ratio, time of operation,length of stay after operation and the complications. Results The achievement ratio of macadam was 95 % （ 171 / 180 ） and 86.7 % （ 39/45 ） in superior segment of ureter and 97.8 % （ 132/135 ） in mid-inferi- or segment of ureter. In all the 9 failure patients, calculus moved up to pelvis in 4 case whose calculus were all in the superior segment of ureter, and 5 cases underwent open operation because of the failure of lens insertion. The average time of operation was 43 min（ 18 - 120 rain）. Length of stay after operation was 3.5 d（ 1 - 8 d）. The complication rate was 4.44% （8/180） ：Four patients suffered from ureter perforation calculus were all in the su- perior segment; three had persistence high fever and one of them also had persistence hematuria; one suffered from renal colic and anuria in 48 h. Conclusion Ureteroscope holmium laser lithotripsy is safe in the treatment of calculus of ureter, especially in those calculus of mid-inferior segment ureter. This operation has the merits of impressive curative effect, diminutive trauma, short length of stay and so on.