输尿管软镜联合钬激光碎石术治疗上段尿路结石的疗效观察

Application of flexible ureteroscopy combined with holmium laser lithotripsy for upper ureter calculi

目的 探讨输尿管软镜联合钬激光治疗上段尿路结石的疗效.方法 回顾性分析2013年1月至2015年3月期间本院采用输尿管软镜联合钬激光碎石术治疗的43例上尿路结石患者临床资料.结石最大直径12 ～27mm.12例患者术前1周留置患侧双J管,术中先经F8/9.8输尿管硬镜镜检留置导丝,沿导丝放置Cook外鞘,再引入奥林巴斯纤维输尿管软镜联合钬激光,尽可能将结石粉碎化,必要时辅助使用套石篮套取出较大的结石碎屑.术后4周复查KUB或双肾CT平扫,评估碎石效果结果.结果 术前留置患侧双J管1周的12例患者均成功一次性进镜;经输尿管硬镜扩张后的软镜一次进镜成功率90.3％ （28/31）,余3例留置双J管2周后行第二次手术全部成功进镜;总进镜成功率为100％（43/43）.总的结石寻及率95.3％（41/43）,钬激光碎石成功率97.6％ （40/41）,4周后结石清除率为70％ （28/40）.平均手术时间为65min（35～150min）.无严重并发症发生.结论 输尿管软镜联合钬激光治疗上尿路结石微创、安全,疗效确切,并发症少,具有良好的应用的前景.

Objectives To evaluate the effectiveness of flexible ureteroscopy combined with holmium laser lithotripsy for upper ureter calculi.Methods From Jam 2013 to Mark 2015,43 cases with upper urinary tract calculi were treated by flexible ureteroscopy combined with holmium laser in our hospital（47 calcuci in total,the diameter diferent from 12 ～ 27mm）.A double-J stent was indwelled in ureter for 1 week before operation in 12 cases.A rigid ureteroscopy was inserted to observed the ureteral lumen,then a ureteric access sheath was placed and Olympus flexible ureteroscopy combined with holmium laser was used to lithotripsy.And evaluated the opration by KUB or CT scan at 4 weeks later.Results The insertion of flexible ureteroscopy in 12 patiens who had a double-J stent indwelled inureter for 1 week before operation was completely success.The other was successful in 90.3.1% （28/ 31） cases,and in 100% （4/4） cases in the second time 2 weeks later.The total success rate was 100%.And the calculi was found in 95.3% （41/43）,the lase lithotripsy success in 97.6% （40/41）,the total calculi clearance was 70% （28/40） at 4 weeks later.The average operation time was 65min （35 ～ 150min）.No serious complication occurred.Conclusions Flexible ureteroscopy combined holmium laser lithotripy is a safe and effective operation for upper ureter calculi.