输尿管软镜钬激光碎石治疗重复输尿管畸形合并上尿路结石5例报告

The application of flexible ureteroscopy with holmium laser in ureteral duplication with upper urinary tract calculi (a report of 5 cases)

目的：探讨输尿管软镜钬激光碎石治疗重复输尿管畸形合并上尿路结石的有效性和安全性。方法回顾2012年7月至2014年5月我院收治的5例采用输尿管软镜钬激光治疗的重复输尿管畸形合并上尿路结石患者的临床及随访资料，结合文献资料进行分析。男性2例，女性3例；平均年龄32．2（25～40）岁；上位肾结石1例，下位肾结石1例，输尿管上段结石2例，输尿管上段结石合并下位肾结石1例。结石大小平均1．5（1．0～2．2）cm。结果4例患者成功碎石，1例因输尿管狭窄上鞘失败改为经皮肾镜碎石术。术后1个月结石完全排净率为75％（3／4），1例残留结石经体外冲击波碎石后结石排出。所有患者术中及术后无输尿管损伤，无明显出血、发热及尿脓毒血症发生。随访3～20个月，结石无复发，患者的肾积水均有不同程度的改善。结论输尿管软镜钬激光碎石治疗重复输尿管畸形合并上尿路结石安全、有效。

Objective To evaluate the therapeutic effect and safety of flexible ureteroscopy with holmium laser for ure‐teral duplication with upper urinary tract calculi .Methods The clinical data and follow‐up results of 5 patients with ureteral duplication and upper urinary tract calculi who were treated with flexible ureteroscopy and holmium laser during July 2012 and May 2014 in our hospital were reviewed retrospectively .Three of the patients were female and 2 were male ,and the average age was 32 .2 years （ranging from 25 to 40 year ） .The mean diameter of calculus was 1 .5 cm （ranging from 1 .0 cm to 2 .2 cm） . The cases included 1 case of upper kidney stone ,1 case of inferior kidney stone ,2 cases of upper ureter stone and 1 case of up‐per ureter stone with inferior kidney stone .Results Four patients underwent flexible ureteroscopy and laser lithotripsy suc‐cessfully ,and another case was converted to percutaneous nephrolithotomy for the ureteral access sheath failed to be placed due to ureterostenosis .The stone‐free rate was 75% （3/4） one month after the procedure ,and one of the patients with residual stone was then treated with extracorporeal shock wave lithotripsy successfully .No significant complications such as injury of u‐reter ,bleeding ,hyperpyrexia or sepsis occurred .During the follow‐up of 3 to 20 months ,there was no recurrence of calculi , and all nephrohydrosis improved in different degrees .Conclusion Flexible ureteroscopy with holmium laser is safe and effec‐tive in the management of ureteral duplication with upper urinary tract calculi .