输尿管软镜技术治疗输尿管上段结石手术技巧探讨

The discussion of flexible ureteroscopy in the treatment of upper ureteral stones

目的 探讨输尿管软镜技术治疗输尿管上段结石的手术技巧.方法 96例输尿管上段结石患者接受一期输尿管软镜钬激光碎石治疗,先以Wolf 8.0 ～ 9.8F输尿管镜在镍钛导丝引导下直接扩张输尿管开口进入输尿管,沿导丝放置一次性导引鞘,遇到输尿管节段性狭窄时,在硬镜下直接置入输尿管球囊进行扩张,扩张后再置入输尿管导引鞘,引入输尿管软镜钬激光碎石,并使用套石篮套取出较大的结石碎片.结果 94例患者一期成功置鞘碎石,2例因输尿管狭窄难以置入输尿管软镜鞘.手术时间30～75 min,平均45 min.术后9例患者寒战发热,无其他严重并发症.术后1个月拔除D-J管,复查CT/KUB,结石清除率94.79％ （91/96）.结论 输尿管软镜钬激光碎石技术是处理输尿管上段结石的有效手段,熟练掌握手术技巧及灵活采用辅助手段,能够显著提高一期输尿管软镜手术的置管成功率.

Objectives To explore the efficacy and surgery skills of flexible ureteroscopic holmium laser lithotripsy in the treatment of upper ureteral stone.Methods 96 cases with upper ureteral stone received flexible ureteroscopic holmium laser lithotripsy in one stage.The target ureter directly was expaned with 8/9.8 F Wolf ureterosope,then the ureteric sheath was inserted,transluminal balloon dilatation was be done for ureterostenosis,then the ureteric sheath was insert again.Flexible ureteroscopy was done,stone was fragmented by holmium laser,and removed by basket.Results 94 patients were treated successfully in one session,3 patients couldnt be done because of ureter ureterostenosis in the first stage.Operation time was 30 ～ 75 min,mean time was 42 minutes.Postoperative fever was noted in 9 cases,no other severe complication occured.D-J tube was removed 1 month after operation,and the stone clearance rate was 94.79%.Conclusions The flexible ureteroscopic holmium laser lithoripsy is a safe and effective way to treat upper ureteral stones.Advanced operation skills and taking full advantages of supplementary means,that significantly improve the success ratio of the flexible ureteroscopic holmium laser lithoripsy in one-stage operation.