输尿管硬镜钬激光治疗输尿管结石的失败原因及并发症分析(附57例报告)

Reason for failure and complication in semirigid ureteroscope lithotripsy with holmium laser(Reports of 57 cases)

目的：分析输尿管硬镜钬激光治疗输尿管结石的失败或并发症发生原因，探讨其防治对策。方法：我院2010年6月～2012年6月间行输尿管硬镜钬激光碎石术治疗输尿管结石而发生输尿管内碎石失败及术中术后并发症者57例，结合文献复习对其发生原因进行回顾性分析。结果：8例因输尿管狭窄在上镜过程中发生输尿管穿孔致碎石失败，14例因输尿管上段扩张结石移位进入肾内致碎石失败，1l例出现输尿管壁损伤出血致碎石失败，17例因输尿管迂曲未能到达结石部位而进输尿管镜失败，1例术中发生输尿管黏膜撕脱，6例术后出现不同程度发热。结论：输尿管硬镜钬激光碎石术常出现出血、穿孔、结石移位残留、感染等并发症，并有可能导致手术失败。临床上应重视这些问题并研究相应的处理对策，熟练的技术操作及严格掌握适应证是减少并发症和降低手术失败率的关键。

Objective：To analyze reason for ~allure and complications and cltscuss now Lo prcvc rigid ureteroscopic lithotripsy with holmium laser. Methods：We retrospectively analyzed 57 patients who failed to undergo ureteroscope lithotripsy and complications occurred perioperatively from June 2010 to June 2012. Results： Eight cases with ureteral stricture resulted in ureteral perforation during placing ureteroseopy. Fourteen cases with upper ureteral expansion resulted in calculi transloeation into the kidney. Eleven cases showd ureteral wall injury bleeding. Seventeen cases failed to reach calculi parts because of ureteral distortion. One case showed ureteral mu- cosa avulsion. Six cases showed postoperative fever. Conclusions： Holmium laser lithotripsy technology in semirigid ureteroscopic lithotripsy often combine with bleeding, perforation, calculi translocation, infection, and sometimes lead to failure of operation. We should pay attention to these problems and the corresponding countermeasures. The skilled technology and strict control of indications is the key to reduce complications and failure rates.