经输尿管镜钬激光碎石术治疗输尿管结石(附350例报告)

Ureteroscopic lithotripsy with holmium laser for ureteral stones(Report of 350 cases)

目的:评价输尿管镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法:采用输尿管镜钬激光碎石术治疗输尿管结石350例,其中结石并息肉35例。结石大小0.6～2.0cm,平均1.2cm,直视下经尿道置入输尿管镜,寻及结石后以600μm激光传导光纤抵住结石,0.8～1.2J/8～12HZ功率钬激光碎石,对结石合并息肉患者,进镜后控制液体灌注速度,上行至结石下方输尿管息肉处,置入钬激光光纤,以1.0～1.5J/6～10HZ功率将息肉切开、气化切除,显露结石,再行钬激光碎石。结果:350例输尿管结石患者单次碎石成功率94%(329/350),一次输尿管息肉切除成功率100%。手术时间20～60min,平均45min,术后住院2～5d,平均3d。21例输尿管上段结石患者,碎石过程中部分残石碎片回漂入肾盂,予以ESWL治疗。随访1～2个月,复查B超及KUB,结石均已排净。无输尿管黏膜穿孔、黏膜撕脱、发热等并发症。结论:输尿管镜钬激光碎石术治疗输尿管结石安全、有效;且对结石并息肉患者,亦可达到满意的治疗效果,是临床治疗输尿管结石最理想的治疗方法。

Objective：Evaluate the safety and effectiveness of ureteroscopic lithotripsy with holmium laser for ureteral stones. Method：A total of 350 cases of ureteral stones, including stones and polyps in 35 cases, was trea- ted by using ureteroscopic lithotripsy with holmium laser. Stone size was 0.6 to 2.0 cm （mean 1.2 cm）. The uret- eroscopy was placed under direct vision transurethrally. After finding the ureteral stone, 600μm laser conduction fiber was placed against the stones, and the lithotripsy was manipulate with holmium laser by setting-up of 0.8-1. 2 J/8-12 HZ power. For the cases of stone with polyps, fluid infusion rate was controlled after the ureteroscopy up to the ureteral polyps, which was alwasys below the stones. The holmium laser fiber was then placed in and polyps was gasification resected by holmium laser with 1.0-1.5 J/6-10 HZ power, and finally the stones were re- vealed for lithotripsy. Result： Of 350 cases of ureteral calculi, the success rate of one-stage stone clearance was 94% （329/350）, and the one-stage clearance rate of ureteral polyp was 100%. The operation time was 20-60 min, with an average of 45min. The postoperative hospital stay was 2-5 days, with an average of three days. For 21 ca- ses of upper ureteral calculi, some residual stone fragments driftted back into the pelvis in the process of lithotrip- sy, and these residual stones were treated with ESWL postoperatively. In the one to two months＇ follow-up, B ul- trasonography and KUB were reviewed, and found that stones have been drained. There were no ureteral perfora- tion of the mucosa, mucosal avulsion, fever and other complications. Conclusion：The ureteroscopic lithotripsy with holmium laser for ureteral stones was safe and efficient. It could also achieve a satisfactory therapeutic effect in the cases of stones and polyps. It was one of the best clinical treatment of the ureteral calculi.