输尿管镜钬激光碎石治疗210例输尿管息肉包裹性结石

Treatment of ureteral calculus encapsulated by granulation tissue with ureteroscopic holmium laser lithotripsy

目的探讨经输尿管镜钬激光碎石术治疗输尿管息肉包裹性结石的疗效。方法收集本院2003年12月至2009年6月期间经输尿管镜钬激光碎石术治疗输尿管息肉包裹性结石210例病例资料,进行回顾性分析。其中,男139例,女71例,年龄17～69岁,单侧202例,双侧8例,结石直径0.8～2.1cm。结果手术成功率89%(187/210),结石直径8～17mm,平均手术时间67±24min,住院时间5～9d,结石排净平均时间19.7±11.3d。碎石失败23例,其中结石体积较大导致碎石不理想4例;输尿管狭窄或者扭曲造成置镜失败或者碎石不理想13例;结石移位被冲入肾盂6例。并发症发生率9%,其中,输尿管口或壁段损伤11例,输尿管穿孔或假道6例,肾周积液并感染1例,输尿管完全撕脱1例。结论经输尿管镜钬激光碎石术治疗输尿管肉芽包裹性结石是一种相对高效、安全的治疗手段。

Objective This study sought to obtain insight into the efficacy and safety of ureteroscopic holmium laser lithotripsy for ureteral calculus encapsulated by granulation tissue, and to characterize the factors may influence the effect of the treatment. Methods 210 patients with granulation tissue-encapsulated ureteral calculus underwent ureteroscopic holmium laser lithotripsy from February 2003 to June 2009 at our hospital were retrospectively analyzed. Results The total success rate was 89% （187/210） with stones ranging in size from 8 to 17 mm, the mean time of operation, hospital stay and stone free being 67±24 min, 2.6±1.4day and 19.7±11.3 day, respectively. Twenty three cases of treatment failure was associated with the large size 15±6 mm of stones 4 cases, abnormality of ureteral structure such as ureterostenosis or ureter twist 13 cases and stones shifting to renal pelvis 6 cases. The overall complications rate was 9% （19/210）, manifestated by ureteral lesion 11 cases, ureteral perforation 6 cases, perirenal hydrops combined with infection 1 cases and complete ureteral laceration 1 cases. Conclusions Our study revealed that ureteroscopic holmium laser lithotripsy is a relatively safe, technically feasible and efficacious treatment for ureteral calculus encapsulated by granulation tissue. The size of stone, abnormality of ureter structure and migration of fragments may be the main factors influecing the effect and the occurrence of complication of the treatment.