输尿管镜钬激光碎石术治疗输尿管结石疗效观察（附498例报告）

Treatment of ureteral calculi with transureteroscopic holium laser lithot：ripsy / report of 498 cases ）

目的 评估比较输尿管镜钬激光碎石术（ureterocopic lithotripsy,URL）治疗输尿管上段结石和中下段结石的疗效.方法 回顾性分析2006年5月至2011年12月在本院治疗的498例输尿管结石患者的临床资料,其中上段结石255例,中下段结石243例,对比观察两种结石治疗的疗效.结果 一次碎石成功率为88.6％ （441/498）.其中上段、中下段结石一次碎石成功率分别为83.1％（212/255）和94.2％（229/243）,差异有统计学意义（P＜0.05）.有体外冲击波碎石（ESWL）史者316例、348例.一次碎石成功率为88.0％ （278/316）,无ESWL史者182例213侧,一次碎石成功率为91.8％（167/182）,差异无统计学意义（P＞0.05）.手术失败共32例32侧,为结石上移入肾盏.手术时间15～130min,平均（41.4±25.6）min,中下段结石组手术时间为（21.39±6.15） min,明显少于上段结石组（37.52±16.41）min,差异有统计学意义（P＜0.05）；术后住院时间2 ～15d,平均（4.7±2.6）d.术后泌尿系感染、发热68例,无输尿管穿孔、撕裂、远期输尿管狭窄等并发疰.两组术后3周进行KUB平片复查,中下段结石组结石排净率为97.9％（238/243）,上段结石组结石排净率为91.0％（232/255）,差异有统计学意义（P＜0.05）；而两组住院时间比较差异无统计学意义（P＞0.05）.结论 经输尿管经钬激光碎石术对输尿管中下段结石的碎石成功率、结石排净率、手术时间方面优于上段结石,经输尿管钬激光碎石术是目前治疗输尿管中下段结石的较理想的一种治疗方法.

Objectives To investigate the efficacy of using ureteroscopic holmium laser lithotripsy to treat patients with ureteral stones.Methods We retrospectively analyzed the clinical materials of 498 cases patients in our hospital using ureteroscopic holmium laser lithotripsy to treat patients with ureteral stones from May 2006 to December 2011,255 cases for upper ureteral stones and others for middle-lower ureteral stones.Results The overall successful rate of fragmentation for all ureteral stones in a single procedure achieved 88.6% （441/498）,and respectively for the upper,middle-lower ureteral stones were 83.1% （212/255） and 94.2% （229/243）,with a significant difference compared between the two groups （P 〉 0.05）.There were 316 cases （348 sides） with ESWL history,and the successful rate of fragmentation in a single procedure was 88.0% （278/316）.182 cases （213 sides） without ESWL history got the successful rate of fragmentation in a single procedure at 91.8% （167/182）,without any significant difference compared with each other（P 〉 0.05）.Operation time ranged 15 ～ 130 min （mean 41.4 ± 25.6 min）,and （mean 22.39 ± 6.15） min for the group of middle-lower ureteral stones,（37.52 ± 8.41） min for the other group,with a significant difference compared.The duration of hospitalization after operation was2 ～ 15d,with an average（4.7 ± 2.6）d.32 sides was abandoned,which migrated to the renal pelvis.The patients were reviewed by KUB plain 3 weeks after lithotripsy.The stone-free rate was 97.9% （238/243） in the middle-lower ureteral stones group,which was significantly higher than that in the upper ureteral stones group 91.0% （232/255,P 〈 0.05）.necessary.There were 68 sides with urinary tract infection and suffered fever with the highest temperature at 40.3℃ and no one with ureteral avulsion or longterm complications such as ureteral stricture.Conclusions The transureteroscopic holmium laser lithotripsy is both mnimally invasive and effective therapy for patients with ureteral calculi,especially for the middle-lower ureteral stones