输尿管镜下钬激光碎石治疗输尿管中上段结石1200例报告

Holmium laser lithotripsy under ureteroscope for mid-upper ureteral calculi(report of 1 200 cases)

目的评估输尿管镜钬激光碎石治疗输尿管中上段结石的安全性和有效性。方法对2005年1月～2010年12月输尿管镜下钬激光碎石治疗的1 200例输尿管中上段结石患者的临床资料进行回顾性分析。结果一次性结石清除率95.4%(1 145/1 200),其中,第三腰椎下缘以上结石为75.7%(28/37),第三腰椎下缘至骶髂关节上缘结石为92.6%(486/525),骶髂关节段结石为98.9%(631/638)。3.6%(43/1 200)患者因碎石移位改行ESWL术。9例出现输尿管穿孔,除2例改开放手术外,7例成功留置双"J"管3月后再次行输尿管镜钬激光碎石获成功。本组手术时间20～90min,平均(45.6±17.4)min,术中未发生大出血、输尿管撕脱、断裂等,术中输尿管黏膜撕裂4例,黏膜下假道形成8例,均顺利留置双"J"管,随访1～6月无尿囊肿和输尿管狭窄形成。术后患侧肾绞痛57例、腹部胀痛24例、发热28例,予以抗感染、对症治疗后好转。术后2～3d拔除导尿管,术后住院天数3～7d,平均(4.3±1.2)d。结论输尿管镜钬激光碎石术,具有微创、高效、并发症少、恢复快等优点,在掌握一定输尿管镜技巧的基础上处理中上段输尿管结石可取得比较好的疗效。但对L3水平以上且直径大于1.0cm的结石不建议使用输尿管镜处理。

Objective To evaluate the safety and efficacy of holmium laser lithotripsy under ureterscope for mid-upper ureteral calculi.Methods Clinical data of 1 200 patients with mid-upper ureteral calculi treated with holmium laser lithotripsy under ureteroscope during Jan.2005 to Dec.2010 were retrospectively analyzed.Results The overall stone-free rate was 95.4%（1 145/1 200）.The stone-free rate was respectively 75.7%（28/37）,92.6%（486/525） and 98.9%（631/638） for stones located upon the third lumbar vertebra,between the third lumbar vertebra and the sacroiliac joint,and within the sacroiliac joint.3.6%（43/1 200） patients switched to extracorporeal shock wave lithotripsy due to translocation of broken stones.9 patients developed ureteral perforation,2 of which received open surgery,and 7 had double-pigtail stent placed and were cured with another holmium laser lithotripsy 3 months later.The operation time was 20～90 minutes（mean 45.6±17.4）.No complications such as hemorrhea,ureteral avulsion or ureteral rupture were found.4 cases developed ureteral mucosa tearing and 8 false passage,but no urinary cyst or ureteral stricture formed after placement of double-pigtail stent.57 cases had nephric colic,24 had belly distending pain,and 28 had fever.All such cases recovered with anti-infectious and ant-symptomatic treatment.Catheters were removed after 2～3 days.Hospital stay after operation was 3～7 days（mean 4.3±1.2）.Conclusion Holmium laser lithotripsy under ureteroscope is highly effective and minimally invasive with few complications and quick recovery.