逆行输尿管镜钬激光碎石术472例分析

Retrograde ureteroscopic holmium laser lithotripsy for ureteral calculi in 472 cases

目的探讨逆行输尿管镜钬激光碎石术治疗输尿管结石的近期疗效。方法 2002年1月至2010年8月输尿管结石472例采用逆行输尿管镜钬激光碎石治疗,输尿管上段结石285例,中下段结石208例,其中含双侧输尿管结石21例。术后2～3周拔除双J管,术后4周B超或尿路X线片观察排石情况。结果总体碎石成功率为87.4%(431/493);其中输尿管中下段碎石成功率为94.7%(197/208),输尿管上段碎石成功率为82.1%(234/285),相比有显著差异(P<0.05)。总体结石清除率为83.7%(361/431),输尿管中下段结石清除率为90.9%(179/197),上段结石清除率为77.8%(182/234),相比有显著差异(P<0.05)。发生结石移位23例,输尿管穿孔损伤17例,输尿管撕脱1例。结论逆行输尿管镜钬激光碎石术治疗输尿管结石是安全高效的方法,娴熟的腔镜技术是提高手术成功率、减少并发症的关键。

Objective To investigate the recent therapeutic effects of the retrograde ureteroscopic holmium laser lithotripsy on the treatment of ureteral calculi with different localizations.Methods Between January 2002 and August 2010,a total of 472 inpatients underwent retrograde ureteroscopy with holmium laser lithotripsy.Of these,21 patients had bilateral ureter calculi.The calculi were located in the middle and lower ureter in 208 patients,and the upper ureter in 285 patients.Ureteral stents were removed 2-3 weeks postoperatively.Patients were assessed 4 weeks postoperatively with ultrasonography or KUB.Results Of the 493 stones,87.4%（431/493） were fragmented in a single procedure.According to the localization of the stones,therapeutic success rate was 94.7%（197/208） for mid-lower ureter stones,82.1%（234/285） for upper ureteral calculi,respectively（P〈0.05）.The stone clearance rate was 83.7%（361/431） after 4 weeks of operation.The stone clearance rate was 90.9%（179/197） for mid-lower ureter stones,77.8%（182/234） for upper ureteral calculi,respectively（P〈0.05）.Stone migration to the kidney and ureteral injury were the main reasons of failure.One case of ureteral avulsion was treated by ureteroureterostomy.Conclusion Retrograde ureteroscopic holmium laser lithotripsy is a safe and effective treatment approach for ureteric calculi,especially for those in the mid-lower ureter.Proficient endourological skills are the keys to increase the success rate and decrease the complication rate.