输尿管镜钬激光碎石术常见并发症原因及策略

Ureteroscopy Holmium Laser Lithotripsy Common Causes of Complications and Strategy

目的探讨分析临床采用输尿管镜钬激光碎石术治疗输尿管结石过程中的常见并发症,并且深入探讨相关应对策略。方法该次调查实验选取2009年1月—2014年1月在该院接受输尿管结石治疗的患者进行调查分析,患者有140例,患者中结石位于输尿管上段、中段、下端的病例数量分别为53、45、42例。给予患者输尿管镜钬激光碎石术治疗,观察临床治疗手术时间、治疗成功率以及手术并发症情况。结果经过钬激光碎石术治疗后,位于输尿管上段、中下段碎石成功率分别为83.01%、95.40%,上段碎石操作中出现2例加行体外震波碎石,中下段碎石操作中出现4例操作失败,出现6例输尿管损伤,其中输尿管穿孔、输尿管黏膜下假道各为2例,输尿管部分断裂以及输尿管黏膜撕脱病例各有1例。结论对于输尿管结石的治疗来讲,采用输尿管镜钬激光碎石术进行治疗具有成功率高、安全无创伤等特点,并且通过提高操作人员操作技巧可以很大程度上降低并发症的发生概率,值得在临床应用中进行推广。

Objective To analyze the clinical use of holmium laser lithotripsy for ureteral stones during a common com- plication, and depth-related coping strategies. Methods The survey experiment selected in January 2009 to Januany 2014 in our hospital patients ureteral stones treated acceptance investigation and analysis, the number of patients with a total of 140 cases of patients with stones located on the ureter, the middle, the number of cases lower, respectively 53,45,42 cases. Administering to the patient holmium laser lithotripsy, clinical observation of the operation time, the treatment success rate and surgical complications. Results After holmium laser lithotripsy, located in upper ureter, the following paragraph gravel success rates were 83.01%, 95.40%, 2 cases of extracorporeal shock wave lithotripsy plus line segment on gravel operations appears in the lower section of gravel operation the operation failed appear four cases, six cases of ureteral injuries occurred, including ureteral perforation, lower ureteral mucosa false passage each two cas- es, ureter and ureteral mucosa avulsion fracture part 1 patient in each case. Conclusion For the treatment of ureteral stones is concerned, the use of holmium laser lithotripsy treatment has a high success rate, non-invasive security fea- tures, and by making the operators operating skills can largely reduce the risk of complications, worthy of promotion in the clinical application.