经输尿管镜钬激光治疗输尿管结石的临床分析(附350例报告)

Clinical Analysis of Ureteroscopic Holmium:YAG Laser Lithotripsy for Ureteral Calculi(350 Cases Report)

目的探讨经输尿管镜钬激光治疗输尿管结石的临床效果。方法选取2009年5月～2011年6月收治的350例输尿管结石患者,均行经输尿管镜钬激光碎石术。结果 350例输尿管结石患者中321例一次碎石成功,治疗成功率为91.7%(321/350)。手术时间平均48.6(20～115)min;术后住院时间平均5.2(4～7)d。术中结石移位18例,其中16例留置双J管后1～4周内再行补救性体外冲击波碎石术,另2例换经输尿管软镜钬激光肾内碎石。D-J管常规留置时间为3～4周。因输尿管迂曲、狭窄不能进镜达结石部位11例,均中转开放手术取石。术中发生输尿管粘膜下损伤6例,输尿管穿孔4例。术后当天出现畏寒、发热,体温>38.5℃者19例,给予静脉抗感染和对症治疗后均恢复正常。术后结石残留造成再次输尿管梗阻6例,经再次输尿管镜碎石术后好转。术后3个月339例获随诊,结石均获清除,结石清除率达96.9%(339/350)。结论经输尿管镜钬激光治疗输尿管结石具有安全、高效、创伤小、并发症少、成功率高、住院时间短等优点,是目前输尿管结石的最理想治疗方法。

Objective To discuss the clinical effects of ureteroscopic holmium： YAG laser lithotripsy for ureteral stones. Method From May 2009 to June 2011, there were 350 patients with ureteral calculi underwent ureteroscopic holmium： YAG laser lithotripsy. Results There were 321 cases （91.7%） got one stage clearance. The mean operation time was 48.6 （20 - 115） min; and the postoperative hospital stay was 5.2 （4 - 7） days. The ureteral stones shifted to the pelvis in 18 cases, which were treated by ESWL 1 to 4 weeks later following D] tubes insertion in 16 cases, and by soft ureteroscopic holmium： YAG laser lithotripsy in the other 2 cases. Another 11 cases conversed to open surgery because of the ureteral tortu- osity or stenosis. There were 6 cases of ureteral mucosa damage and 4 cases of ureteral perforation. During the 3 months follow-up, 339 cases were found all got stone clearance. So the stone clearance rate of this group was 96.9%. Conclusion It is an ideal treatment for ureteral calculi of ureteroscopic holmium： YAG laser lithotripsy with advantages of safety, high efficacy, minimal invasion, less complications and quick rehabilitation.