输尿管软镜下钬激光碎石术治疗上尿路结石——附126例报告

Treatment of Upper Urinary Calculi with Holmium Laser Lithotriptor under Flexible Ureteroscope(Appended with Report of 126 Cases)

目的探讨输尿管软镜下钬激光碎石术治疗上尿路结石的疗效。方法上尿路结石患者126例,其中右侧结石75例,左侧结石51例。输尿管上段结石33例,输尿管上段合并肾结石29例,肾结石64例。结石大小0.6～2.0 cm,平均1.33 cm。经输尿管硬镜扩张后留置输尿管扩张鞘寻找结石,采用输尿管软镜下钬激光碎石术治疗,光纤直径200μm,能量0.8～1.0 J,频率5～10 Hz。结果单次碎石成功117例(占92.86%),手术时间25～75 min,平均48 min。术后6例出现低热,无脓肾、输尿管穿孔等并发症。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,尤其适用于输尿管上段、肾盂、肾中盏及肾上盏结石。

Objective To evaluate the clinical effect of holmium laser with flexible ureteroscope on upper urinary calculi. Methods All 126 patients of upper urinary calculi were treated with Holmium laser lithotriptor under flexible ureteroscope in our hos- pital. Of them, 75 patients had calculi in the right side and 51 patients in the left side. The calculi were in the kidney for 64 patients, in the upper ureteral for 33 patients, and both in the upper ureteral and kidney for 29 patients. The diameter of the calculi ranged 0. 6- 2. 0 cm, mean 1.33 cm. After ureter dilation and placement of ureteral access sheath, the stone were fragmented and removed with 200p^m Ho：YAG laser fiber, energy 0. 8-1.0 J, frequency 5-10 Hz . Results The successful rate of stone fragmentation after single session was 92. 86% （117/126）. Mean operation time was 48 rain（23- 71 min）. Six patients had low fever after the operation. Neither ureteral perforation nor pyonephresis was observed. Conclusions The therapy of Holmium laser lithotriptor under flexible ureterescope is safe and effective for upper urinary calculi, espe- cially for upper ureteral, pelvis, middle calyx and upper calyx stones.