钬激光治疗输尿管结石术后并发症原因分析

Analysis on complication of lithotripsy of ureteral calculus by ureteroscope holmium laser

目的分析钬激光治疗输尿管结石术后并发症的原因。方法回顾性分析2008年10月～2009年11月期间成都第二人民医院泌尿外科收治的147例采用输尿管镜下钬激光治疗输尿管结石,13例出现并发症的原因及治疗措施。结果 13例中,输尿管损伤8例(包括输尿管撕脱1例,输尿管断裂1例,输尿管穿孔3例,输尿管粘膜下隧道3例),输尿管结石移位3例,术后感染2例,发生率8.8%,并发症的发生与输尿管开口方向异常、输尿管口水肿、走行迂曲、输尿管狭窄、输尿管息肉阻塞输尿管腔、术者经验缺乏等有关,也与导管或导丝误刺入输尿管壁,激光损伤,甚至击穿输尿管壁等有关。均得到及时处理,最终治愈。结论输尿管损伤和结石移位是手术主要并发症,开展该手术早期经验欠缺,操作不规范等可能导致严重并发症。对其原因正确认识并合理处理,积极改进,规范操作可以取得良好疗效。

Objective To analyze the complication of lithotripsy of ureteral calculus by ureteroscope holmium laser. Methods 13 cases with complications among 147 patients with ureteral calculus treated by ureteroscope holmium laser from Oct 2008 to Nov 2009. Results There were injuries of ureter in 8 cases including 1 avulsion of ureter, 1 disruption of ureter, 3 perforation of ureter, shifting of ureteral stone in 3 cases, postoperative infection in 2 cases. All cases were treated successfully with appropriate operation. The reasons of the complication including stenosis of ureter, distortion of ureter, inflammation or edema of the ureteral orifice, deficiency of experience. Conclusion Injury of ureter and shifting of ureteral calculus is the primary complication. The most serious complications usually occur in early stage without any experience. Ureteroscope holmium laser is a effective, convenient and safe method for treatment on ureteral calculus avoiding these complications.