输尿管镜下钬激光碎石术治疗L_5～L_3嵌顿性输尿管上段结石的手术技巧及其临床疗效

The Surgical Skills and the Clinical Effect of L_5-L_3 Impacted Ureteral Stones Treated with Transureteroscopic Holmium YAG Laser Lithotripsy

目的:探讨输尿管镜下钬激光碎石术治疗L5~L3嵌顿性输尿管上段结石的手术技巧及其临床疗效。方法:选取2013年3月-2014年10月应用输尿管镜下钬激光碎石术治疗嵌顿性输尿管上段结石56例患者,结石大小0.7 cm×0.5 cm^1.6 cm×0.8 cm。结果:本组56例输尿管结石患者单次手术结石粉碎率92.9%(52/56),1例因输尿管扭曲严重,输尿管镜无法到达结石处,中转开放手术,3例因输尿管结石较硬,碎石过程中结石滑入肾内,平均手术时间28 min,平均术后住院时间3 d。术中及术后无输尿管黏膜套脱,输尿管穿孔,肾破裂,高热,脓毒血症等并发症。结论:输尿管镜下钬激光碎石术治疗L5~L3嵌顿性输尿管上段结石,临床效果满意,术中需注意手术技巧,避免手术并发症的发生,提高临床疗效。

Objective： To investigate the surgical skills and the clinical effect of Ls-L3 impacted ureteral stones treated with transureteroscopic holmium YAG laser lithotripsy.Method： 56 patients from march 2013 to October 2014 diagnosed with impacted ureteral stones were treated with, transureteroscopic holmium YAG laser lithotripsy.the size of stones were from 0.7 cm × 0.5 cm to 1.6 cm×0.8 cm.Result： The fragmentation rate in single procedure was 92.9% （ 52/56 ）, one case was conversed to open surgery due to the severity tortuosity of ureter that led to failed ureteroscope insertion. The stones of three cases slipped into the renal in the process because of stones harder.the mean operation time were 28 mino the mean postoperation hospital stay time were three days. The complications did not take place in and after operations such as ureter perforation, ureterodialysis, renal rupture, hyperthermia and sepsis. Conclusion： The clinical result of the L5-L3 impacted ureteral stones that were treated with transureteroscopic holmium YAG laser lithotripsy is satisfactory.If you want to avoid the operative complications and enhance clinical effect, you should play attention to surgical skills.