输尿管镜钬激光治疗输尿管结石1015例疗效分析

Therapeutic Effects of Transurethral Holium Laser Lithotripsy for Ureteric Stones: a Report of 1015 Cases

目的总结输尿管镜钬激光碎石治疗1015例输尿管结石的临床体会。方法 2004年11月～2013年12月采用输尿管硬镜钬激光碎石治疗输尿管结石1015例,680例输尿管中下段结石仅用输尿管硬镜钬激光碎石,在335例输尿管上段结石中,对前期186例碎石中漂入肾盂内结石或〉6 mm碎石同期用输尿管软镜碎石或分期ESWL,后期146例应用NTrap网蓝预防输尿管上段结石漂入肾盂,当有结石或〉6 mm碎石漂入肾盂时同期用输尿管软镜或分期ESWL碎石。结果输尿管中下段结石碎石成功率97.5%（663/680）。输尿管上段结石单纯输尿管镜钬激光碎石成功率60.2%（112/186）;对漂入肾盂结石或碎石同期应用输尿管软镜碎石,碎石成功率88.2%（164/186）;输尿管硬镜钬激光碎石前辅以NTrap网篮成功碎石率89.9%（134/149）。进镜失败6例,输尿管穿孔3例,假道7例,输尿管撕脱1例,尿脓毒血症2例,肾周血肿1例。756例（输尿管上段结石255例,下段结石501例）随访6～12个月,临床症状均消失,B超复查190例,肾盂、肾盏扩张消失176例,明显好转14例,无结石复发,其中24例漂入肾盂≤6 mm碎石,经药物治疗排出碎石5例,19例无变化。结论输尿管镜钬激光碎石治疗输尿管中下段结石安全、有效,对输尿管上段结石辅以NTrap网篮或输尿管软镜有助于提高成功碎石率。

Objective To summarize the experience of ureteroscopic holium laser lithotripsy for the treatment of ureteric stones. Methods We analyzed retrospectively a series of 1015 patients with ureteral stones who underwent ureteroscpic lithotripsy from November 2004 to December 2013. Among them, 680 patients with lower and middle ureteral stones were treated by holium laser lithotripsy through a rigid urteroseopy. While for the 335 patients with upper ureteral stones, fexible ureteroscopie lithotripsy or staged ESWL was used for stones escaped into the renal pelvis or 〉 6 mm in 186 patients during initial period and the NTrap baskets were additionally applied for prevention of stones entering the renal pelvis in the remaining 146 patients during the later period. Results The stone-free rate was 97.5% （663/680） in patients with middle and lower ureteric stones and was 60.2% （112/186） in patients with upper ureteric stones. In patients with stones entering the renal pelvis or undergoing fexible ureteroseopic lithotripsy, the stone-free rate was 88.2 % （164/186）. In patients receiving NTrap basket indwelling before the transurethral holium laser lithotripsy, the stone- free rate was 89. 9% （134/149）. There were 6 cases of failed inserting ureteroscope, 3 cases of ureter perforation, 7 cases of pseudocanal, 1 case of avulsion of ureter, 2 cases of urinary sepsis, and 1 case of perirenal hematoma. Follow-up examinations for 6 - 12 months in 756 cases （ including 255 cases of upper urteral stones and 501 cases of lower Ureteral stones） showed disappearance of clinical symptoms. B-uhrasonography in 190 cases showed disappearance of dilatation of renal pelvis and calices in 176 cases and significant improvement in 14 cases. No recurrence happened. There were 24 cases of fragment ≤ 6 mm entering the renal pelvis, 5 of which were cured with drug administration and 19 of which were noted no changes. Conclusions Holium laser lithotripsy via ureteroseope is an effective and safe minimal invasive surgery for the treatment of lower and middle ureterie stones. The stone-free rate is relatively high in patients with upper ureteric stones, if NTrap basket or flexible ureteroscopy is additionally utilized.