输尿管镜钬激光碎石术治疗急性梗阻性肾功能衰竭

Ureteroscopic holmium laser lithotripsy in treatment of patients with acute obstructive renal impairment

目的探讨上尿路结石引起的急性梗阻性。肾衰的治疗方法。方法采用输尿管镜直视下取石、钬激光碎石或将结石推入。肾盂，体外冲击波碎石（ESWL）治疗急性梗阻性肾衰32例（62侧）。所有患者输尿管镜检查术前未曾放置输尿管支架或肾盂引流管。结果30例输尿管中下段结石经输尿管镜直视下取碎石成功，碎石成功率93．7％。2例输尿管上段结石被推入肾盂，行ESWL治疗后11个月，结石排净。术后患者肾功能恢复正常或接近正常，尿量恢复，结石排净率100％。结论输尿管镜下取石、钬激光碎石治疗结石引起的急性梗阻性肾衰是一种安全、有效、创伤小、术后恢复快且可同时处理双侧输尿管的手术方式，可作为上尿路梗阻并发急性肾功能衰竭的首选治疗方法。

Objective To evaluate the efficacy and safety of holmium laser for treatment ureteric stones in patients with acute obstructive renal impairment. Methods Thirty-two patients were included in this study. None of the patients had a ureteric stent or nephrostomy tube before the ureteroscopy. All patients were treated with holmium laser. Results 30 patients with ureter stones in middle and inferior segment were free of stones by ureteroscopic lith- otripsy. The success rate for treatment of ureteral stones lithotripsy and calculus removal was 93.7%. Ureter stones located in superior segment in two patients were sent back pelvis. Extracorporeal shock-wave lithotripsy were performed. The two patients were free of any stone fragmens a month later. In all patients, including the five with obstructive anuria,the renal impairment resolved or improved as evidenced by normalization or fall in blood urea and creatinine. 100% of the patients were free of any stone fragments postoperatively. Conclusion A holmium laser was a safe and effective modality of ureteroseopic lithotripsy in patients with significant renal impairment or even obstructive anuria. It also had merits of small wound and fast postoperation recovery. Treatment of beth-side ureteral stones could be han- dled at the same time. The use of holmium laser by ureteroseopy could be considered the first choice in patients with acute obstructive renal impairment.