输尿管软镜钬激光碎石术治疗上尿路结石的疗效分析

Efficacy of Flexible Ureterorenoscopy with Holmium laser Lithotripsy for the Treatment of upper Urinary Calculi

目的探讨输尿管软镜钬激光碎石术治疗上尿路结石的安全性及有效性。方法回顾分析2012年6—10月输尿管软镜钬激光碎石术治疗18例上尿路结石患者资料。男12例,女6例。年龄23～49岁,平均36岁。其中3例为双侧输尿管上段结石,3例为单侧输尿管上段结石,结石位于肾上极4例,中部4例,下极4例。结石最大直径3.2cm。术前均行IVP及双肾CT检查,术前2周均留置双J管(1例单侧输尿管上段结石除外),腰硬联合麻醉下行输尿管软镜钬激光碎石术,常规留置输尿管扩张鞘(1例单侧输尿管上段结石除外),较大结石用套石篮取出,小结石术后体位排石。结果该组18例均顺利置入输尿管软镜,一次进镜成功率100%。17例均可用输尿管软镜寻及结石,并成功碎石。另外1例肾下盏结石需二次软镜碎石,术后仍残留。碎石成功率94.4%。平均手术时间90min,术后平均住院日3d,手术无并发症发生。术后随访1～3个月,患者症状均消失,未见结石复发。结论输尿管软镜下钬激光碎石术治疗上尿路结石安全、有效,尤其适用于结石体积较小、肾盏无明显积水,以及因解剖特点预期体外冲击波碎石效果不佳的患者。

Objective To evaluate the therapeutic effect of flexible ureterorenoseopy （F-URS） with holmium laser lithotripsy in managing upper urinary calculi. Methods The records of 18 patients by flexible reterorenoscopy （F-URS） with holmium laser lithotripsy in managing upper urinary calculi from June 2012 to December 2012 were retrospectively reviewed. The 18 cases aged from 23 to 49 years with an average age of 36. 12 patients were male and 9 were female. All patients had upper urinary stone with 4, 4, and 4 cases had a upper urinary stone in the upper pole, midkidney, and lower pole, respectively and 3 cases had double side of upper ureteral calculi and 3 had one side of upper ureteral calculi. The diameter of the largest stone was 3.2 cm. All pa- tients except one with one side of upper ureteral calculi were placed Double-J stent two weeks before operations and all of them underwent intravenous urography and renal computed tomography （CT）. Flexible ureterorenoscopy with holmium laser lithotripsy were carried out under combined spinal epidural anesthesia. Except one patient with one side of upper ureteral calculi, all patients were indwelled ureter expansion sheath routinely. Large stones were taken out uing stone basket and small stones were expeled through the body position postoperatively. Results 18 patients were placed with flexible ureterorenoscopes with success rate of 100%. Flexible ureterorenoscopes were available for finding stone in 17 cases and successfully crushed stone. Another one patient with stone in the lower pole of kidney needed flexible ureterorenoscopes to crush stone twice and still had stone postoperatively. The success rate of crushing stone was 94.4%. All patients were symptom free after operation.The average operative time and hos- pital stay were 90 minutes and 3 days,respectively. No severe complications occurred. A follow-up of 1 ~3months showed no re- currence. Conclusion F-URS using a holmium laser lithotripsy is a safe and effective for upper urinary calculi, especially for pa- tients with small stone, no hydronephrosis, and patients with little effect when using extracorporeal shock wave lithotripsy because of anatomical features.