输尿管镜下钬激光碎石术治疗输尿管结石临床分析

Application of Ureteroscopic Holmium Laser Lithotripsy in Treating Ureteral Calculi

目的探讨输尿管镜下钬激光碎石术治疗输尿管结石的临床效果。方法选取2007年8月—2010年4月收治的450例输尿管结石患者,皆行输尿管镜检查,并根据情况行钬激光碎石术。结果 450例输尿管结石患者386例成功碎石。手术时间30~126 min,平均51.8 min。术中结石移位38例,因输尿管迂曲、狭窄不能进镜达结石部位26例。术中发生输尿管黏膜下损伤12例,输尿管穿孔5例。术毕不能成功留置双J导管患者28例,分别给予暂时留置输尿管导管或不留置导管。术后体温〉38.5℃者47例,给予静脉抗感染和对症治疗后皆获得好转。术中发现结石移位者38例,术后5~7 d再行补救性体外冲击波碎石术。双J导管常规留置时间为2~4周。术后结石残留造成再次输尿管梗阻8例,经再次输尿管镜碎石术后皆好转。术后输尿管狭窄2例,经开放手术行狭窄段切除吻合术后好转。术后3个月随诊,结石清除率达90%。结论输尿管镜下钬激光碎石术是一种安全、有效的治疗输尿管结石的方法,手术安全性高,适合在基层医院推广应用。

Objective To explore the clinical effectiveness of using ureteroscopic holmium laser lithotripsy in treating ureteral calculi.Methods Totally 450 patients with ureteral calculi underwent ureteroscopy from August 2007 to April 2010.Holmium laser lithotripsy was performed when appropriate.Results Of these 450 patients,calcili were successfully crushed in 386 patients.The average operation duration ranged 30 ~126 min（mean：51.8 min）.Stone migration into pelvis took place in 38 cases during operation,while 26 cases failure to access the stone due to ureteral kink and stricture.Twelve cases had submucosal trauma and 5 had ureteral perforation.Temporary ureteral catheter or no stent were used in 28 cases who failed to be inserted with double-J stent after lithotripsy.In 47 cases,postoperative fevers（over 38.5 ℃） were all relieved by intravenous anti-infection and symptomatic treatments.Salvage extracorporeal shock wave lithotripsy were used to treat stone migration 5~7 days after operation.The double-J stents were remained for 2 to 4 weeks.Residual stone fragments in 8 cases which caused re-obstacle were all relieved by a second time ureteroscopy and holmium laser lithotripsy.Two cases with ureteral stricture were cured by open stenosis resection and anastomosis.The overall stone free rate was above 90% after 3 months of follow-up.Conclusion The ureteroscopic holmium laser lithotripsy is a safe and effective method to treat ureteral calculi.Due to its high operation safety,it is worth to be utilized and promoted in primary clinics.