局麻下输尿管镜钬激光碎石术治疗输尿管结石86例临床分析

Ureteral holmium laser lithotripsy under local anesthesia for 86 cases of ureteral calculi

目的探讨局麻下输尿管镜钬激光碎石术治疗输尿管结石的有效性及安全性。方法回顾性分析2008年5月~2010年5月收治的在局麻下应用输尿管镜钬激光碎石术治疗输尿管结石86例患者的临床资料。所有患者均有轻~中度肾积水,18例合并结石远端输尿管狭窄,19例合并单纯息肉,25例合并息肉包裹结石,13例为体外冲击波碎石（ESWL）治疗失败后,7例曾行输尿管切开取石术,5例并发结石嵌顿与输尿管粘连,5例伴有感染、高热,2例为孤立肾。结果 86例患者中,79例患者单次碎石成功,单次碎石成功率91.9%（79/86）;3例在碎石过程中移位入肾盂后行ESWL,4例因输尿管扭曲、穿孔、黏膜下假道改为开放手术。结论局麻下输尿管镜钬激光碎石术治疗输尿管结石是一种微创、安全、高效、可重复的手术方法。

Objective To evaluate the efficacy and safety of holmium laser lithotripsy under local anesthesia to treat ureteral calculi.Methods Clinical data of 86 cases of ureteral calculi treated with holmium laser endoscopy during May 2008 to May 2010 were retrospectively reviewed.All 86 cases had hydronephrosis,Among them,18 cases were complicated with ureteral stricture,19 with simple polypus,25 with polypus-surrounding calculi,5 with calculi impaction and ureteral adhesion,5 with infection and fever,2 with solitary kidney,13 had failed in extracorporeal shock-wave lithotripsy（ESWL）,and 7 had undergone ureterolithotomy.Results Of the 86 cases,79 was successful with one treatment session,the clearance rate being 91.9%.3 cases changed to ESWL when the stones entered the pelvis of ureter.4 cases changed to open surgery because of ureteral distortion,perforation,and submucous false passage.Conclusions Ureteral holmium laser lithotripsy under local anesthesia is a minimally invasive,safe,effective and repetitive method for ureter calculi.