输尿管镜下钬激光碎石常见并发症原因分析对策

Analysis and Prevention of Common Complications Caused by Ureteroscopic Holmium Laser Lithotripsy

【目的】探讨输尿管镜钬激光治疗输尿管结石的并发症的原因及预防措施。【方法]2010年4月至2013年3月，本院112例输尿管结石采用F9号wolf输尿管镜钬激光碎石系统治疗的I临床资料进行分析。【结果】在治疗过程中有20例发生了不同程度的并发症，包括输尿管镜置入失败3例；输尿管损伤（穿孔，黏膜下隧道）及膀胱损伤共5例，其中2例放置I）IJ管后治愈，余3例开放手术取石并修复损伤的榆尿管；输尿管碎石过程中全部或部分结石上移至肾盂9例，术后行体外振波碎石（ESwL）治愈。术后感染高热2例，其中1例发生感染性休克。术后严重血尿1例。【结论】针对各并发症不同原因，采取相应措施干预，能有效地预防和处理各并发症，其关键在于术前认真准备，术中娴熟而仔细的操作。

[Objective]To explore the causes and preventive measures for complications of ureteroscopic Holmium laser lithotripsy in the treatment of ureteral calculi. [Methods] From April 2010 to March 2013, 112 cases of ureteral calculi were treated with F9 Wolf ureteroscopic Ho：YAG gravel system in our hospital. A- mong them, 21 cases were upper segment ureteral calculi, and 12 cases were middle segment ureteral calculi, and 79 cases were lower segment ureteral calculi. [Results] In the course of treatment, intraoperative compli- cations in different degree occurred in 20 cases including 3 cases of the failure of ureteroscopy and 5 cases of u- reteral injury （perforation and submucosal tunnel） and bladder injury in which 2 cases were cured by the place- ment of double-J stent and the other 3 cases were converted to open surgery to repair the injured ureters. In the process of ureteral gravel, all or some of the stones in 9 cases moved up into renal pelvis, and were cured with ESWL after operation. Postoperative infection and high fever occurred in 2 cases in which one case suffered from infective shock. Postoperative severe hematuria occurred in one case. [Conclusion]The causes of the com- plications and appropriate preventive measures are found through the analysis and summary of common compli- cation in the process of ureteroseopic gravel.