输尿管镜钬激光碎石术治疗输尿管下段结石及输尿管镜进镜技巧探讨

The application of holmium laser lithotripsy with ureteroscope in the treatment of lower ureteral calculi and the experience of ureteroscope insertion

目的评价输尿管镜钬激光碎石术在治疗输尿管下段结石中的应用价值,并探讨输尿管镜的进镜技巧。方法回顾性分析2006年8月至2010年5月我院泌尿外科采用经输尿管镜钬激光碎石术治疗输尿管下段结石102例。102例患者中82例既往有体外震波碎石史,38例患者伴有结石周围息肉形成,在泥鳅导丝的引导下,采用直接挑起进镜法、翻转90°进镜法或翻转180°进镜法所有患者均可顺利将输尿管镜置入患侧输尿管。结果 102患者术中均完全清除结石,平均手术时间为18.5±6.9min,均未发生输尿管穿孔及输尿管黏膜剥脱等严重并发症;4例患者术后发生轻中度发热,经抗炎对症治疗好转。结论遵循一定的进镜技巧,输尿管镜可顺利置入患侧输尿管。输尿管下段结石的钬激光治疗疗效确切、成功率高,可一次完全清除结石,特别是对于合并有息肉的输尿管下段结石,可降低多次体外震波碎石的费用。

Objective To evaluate the value of holmium laser lithotripsy through ureteroscope in the treatment of lower ureteral calculi and discuss the technique of ureteroscope insertion.Methods From August 2006 to May 2010,102 cases of lower ureteral calculi who underwent holmium laser lithotripsy with ureteroscope were retrospectively analyzed.Among all cases,82 patients underwent ESWL but failed,and 38 patients accompanied by surrounding polypi.Under the guidance of loach wire,the direct insertion method,90 degree turnover insertion method or 180 degree turnover insertion method,the ureteroscope could be smoothly inserted ureter among all cases.Results The clearance rate of calculus was 100%（102/102）.The average operation time was 18.5±6.9 min.There was no ureteral perforation and ureteral mucosal avulsion in all 102 cases.Four patients had mild or moderate postoperative fever who recovered under symptomatic treatment.Conclusions Holmium laser lithotripsy with ureteroscope for lower ureteral calculi was safe and effective.It deserved further clinical application.