经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石

Experience of using holmium laser lithotripsy for ureteric stones in children

目的探讨经输尿管镜钬激光碎石术治疗婴幼儿输尿管结石的可行性和疗效。方法回顾性分析2008年12月至2010年10月36例41侧婴幼儿输尿管结石采用经输尿管镜钬激光碎石术治疗的临床资料。结果36例41侧输尿管结石，其中32侧一次人镜碎石成功；8侧采用导丝、输尿管导管、双J管扩张后碎石成功；1侧改经皮肾穿刺钬激光碎石术。所有病例术后均留置双J管1～4周，拔管后2周内复查B超或KUB结石全部排尽，清石率97．6％。7侧合并有输尿管息肉者，息肉切除。发生输尿管口撕裂1例，黏膜下假道2例，留置双J管4周，无输尿管反流和狭窄并发症。1例出现术后发热，经抗感染后体温正常。所有病例术后随访3～24个月未见输尿管狭窄和结石复发。结论选择合适的输尿管镜，熟炼掌握操作技术，采用经输尿管肾镜钬激光碎石术治疗婴幼儿输尿管结石安全有效。

Objective To evaluate the feasibility and efficacy of holmium laser lithotripsy for u- reteric stones in children. Methods A retrospective analysis of pediatric patients with ureteric stones and treated by holmium laser lithotripsy between December 2008-October 2010 was done. Results A total of 36 cases （41 sides） were treated. 32 sides had successful ureteroscopic lithotripsy of stones; 8 sides require guidewire, ureterie stent or doubie-J catheter dilation to achieve success; 1 side needed a change to perculaneous holmium laser lithotripsy. 7 cases had associated uretera polyps. All patients had post-lithotripsy indwelling double J catheter for 1 to 4 weeks. Routine assessment of stone clear- ance was done for all patients using USG or KUB 2 weeks after double-J stent removal. Stone clear- ance rate was 97. 6%. All patients were followed up for 3-24 months, no ureteric stenosis and stone recurrence was seen. Conclusions Ureteroscopic holmium laser lithotripsy in infants and young children is safe and effective for ureteral stones in experienced hands.