软镜钬激光治疗上尿路结石的技巧及疗效分析

The operation skills and curative effects of flexible ureteroscopy combined with holmium laser lithotripsy for renal and upper ureter calculi

目的研究输尿管软镜钬激光治疗上尿路结石的操作技巧及疗效分析。方法选择2014年7月至2015年9月收治的46例输尿管软镜钬激光碎石病例。结石直径10~25 mm。术前常规放置输尿管支架1周,术中输尿管硬镜探查患侧输尿管,导入软镜输送鞘,Olympus F7.5输尿管软镜碎石。若推送鞘无法插入,可直接插入输尿管软镜。术后1 d泌尿系统X线平片（KUB）检查,了解碎石及输尿管支架情况;术后28 d复查KUB或双肾CT平扫,评估碎石效果。结果术前常规放置双J管1周后输尿管硬镜探查,可降低输尿管严重损伤的风险,有利于放置较大的软镜输送鞘。低能量、高频率的激光碎石,可将结石粉末化,增加排石率。软镜总进镜成功率95.6%（44/46）,钬激光碎石成功率95.4%（42/44）,2例患者无法进镜改经皮肾镜碎石。4周后结石清除率为90.5%（38/42）。3例残余结石经体外碎石后治愈。总的结石清除率为93.2%（41/44）。手术时间60-155 min,平均76 min。无一例发生严重并发症。结论输尿管软镜钬激光碎石是治疗直径10-25 mm肾和输尿管上段结石的安全有效的方法,也可以作为体外冲击波碎石失败和经皮肾镜碎石术后残留结石的治疗选择。

Objective To evaluate the efficacy and operation skills of the flexible ureteroscopy with Holmium laser lithotripsy for renal and upper ureter calculi. Methods From Jul. 2014 to Sep. 2015 , 46 cases of renal and upper ureter calculi （size between 10 to 25 mm in diameter） , were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospital. A F5/F6 double-Jstent was placed one week be-fore operation. A rigid ureteroscopy was inserted to observe the ureteral lumen, then a Olympus F7. 5 flexible ureteroscopy with Holmium laser lithotripsy was used to perform the procedure, and a F5/F6 double-J stent had been used at the end of procedure. When the insertion of rigid ureteroscopy and ureteric access sheath was difficult, the flexible ureteroscopy would be inserted directly via a guide-wire. A follow up by KUB was done 1 day after the procedure to evaluate the result. A follow up by KUB or noncontrast CT scan was done 28 days after the procedure to evaluate the results. Results The insertion of flexible ureteroscopy was successful in 95. 6% （44/46 ） cases in the first time. The calculi were detected in 44 cases, and laser lithotripsy succeeded in 42 cases（95.4% ）. 38 cases out of 44 （90. 5% ） had stone clearance at 4 weeks after primary operation, and 3 cases undergone ESWL, the total stone clearance rate was 93. 2% （41/44）. The average operation time was 76 minutes（60 -155 minutes）. No serious complication occurred. Conclusions Flexible ureteroscopy combined with holmium laser lithotripsy is a safe and effective procedure for upper tract calculi , it is a better option for ESWL failed and PCNL residual calculi.