输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石112例

Study on treatment of upper ureteral calculi using rigid ureteroscope and holmium :YAG laser lithotripsy (report of 112 cases)

目的探讨输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石的临床效果及安全性。方法应用输尿管硬镜下钬激光碎石取石术治疗112例输尿管上段结石患者。男63例,女49例,年龄18-87岁（46.7±13.6岁）,左侧61例,右侧46例,双侧5例。结石长径0.7-2.2 cm（1.2±0.5 cm）。26例合并输尿管息肉,31例曾行体外冲击波碎石术,所有患侧肾脏均合并不同程度肾积水。结果手术成功率88.4%（99/112）,手术时间15-80 min（33.6±16.8 min）,术后住院天数3-14天（4.7±2.1天）。所有患者均无严重肉眼血尿、输尿管穿孔、粘膜撕裂、输尿管镜石街形成等并发症。3例患者出现畏寒、高热,其中1例发展为尿源性脓毒血症,予以积极抗感染治疗后,症状逐渐缓解。结论输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石是安全,有效的治疗方法。

Objective To investigate clinical effect and safety of holmium ： YAG laser lithotripsy under ureteroscopy for managing upper ureteral calculi. Methods The clinical data of 112 cases of ureter calculi treated by ureteroscope with Holmium laser lithotripsy were retrospectively analyzed.Among these patients, 63 were male, and 49 were female. The age of the patients varied between 18 -87 years with a mean age of 46.7 years. The largest diameter of the largest stone was 0.7 -2.2 cm（1.2 ±0.5 cm）. There are 5 cases of bilateral upper ureteral calculi, and the total number of left upper ureteral calculi was 61, and the right side was 46. There were 26 cases affiliated with ureteral polypus, and 31 cases with ESWL treatment history preoperative. All the cases had different degrees of hydronephrosis. Results The overall successful operation rate for all level of ureteral stones in single procedure was 88.4%（99 / 112）. The operation time ranged 15 -80 min（33.6 ±16.8 min）, and the postoperative hospital stay was 3 -14 d（4.7 ±2.1 d）. No complications occurred such as severe hematouria, ureteral perforation, ureteral avulsion and ureteral stone street in this post cohort operation.There were three cases with urinary tract infection and suffered fever. Urosepsis occurred in one case,and cured by timely anti-infection treatment. Conclusion Rigid ureterorenoscopy using Ho ：YAG laser lithotripsy for upper ureteral calculi can be an effective and safely performed technique.