输尿管软硬镜联合钬激光治疗复杂上尿路结石

Flexible ureteroscopy combined with rigid ureteroscopy and holmium laser lithotripsy for complicated upper ureter calculi

目的 探讨输尿管软镜硬镜联合钬激光治疗复杂上尿路结石的手术技巧及疗效.方法 选取2015年2月至2017年12月上尿路结石患者60例,均采用输尿管软镜与硬镜联合钬激光碎石治疗,首先以F8/9.8输尿管硬镜检查患者输尿管结构,留置亲水导丝,顺导丝再置入软镜鞘,缓慢插入输尿管软镜,直视下钬激光碎石,清理结石颗粒.结果 60例患者中52例一期顺利碎石,8例因输尿管迂曲、狭窄置入输尿管软镜鞘,留置F6输尿管支架管10～14 d,二期成功碎石.术后1例出现发热,无输尿管穿孔、撕脱等严重并发症.手术时间40～90 min,平均50 min.术后2～3周后复查多普勒彩色超声,清石率为91.5％,4～6周拔出输尿管支架管.结论 输尿管软硬镜联合钬激光治疗复杂上尿路结石是一种有效的术式,患者创伤小,康复快.

Objective To investigate the clinical effect of rigid ureteroscopy and flexible ureteroscopy combine with holmium laser lithotripsy on complicated upper ureter calculi. Methods Sixty patients with upper urinary calculi from February 2015 to December 2017 were selected, all of whom were treated with ureteroscope combined with rigid microscope using holmium laser lithotripsy. Firstly the ureteral structure of the ureter was examined by F8/9.8 ureteroscopy, indwelling hydrophilic guidewire, and then along the guidewire into ureteric sheath for flexible, flexible was done slowly, stone was fragmented by holmium laser lithotripsy, that was seen directly, the stone particles were cleaned. Results Fifty-two of the 60 patients were treated with primary lithotripsy, and 8 cases were treated with ureteral flexible en- doscopic sheath due to ureteral tortuosity and stricture, F6 ureteral stent tube was retained for 10 - 14 days, gravel was successfully removed in the second stage. Fever occurred in 1 cases, and there were no serious complications such as ureteral perforation and avulsion after sugery. The operation time was 40 - 90 min, and the average time was 50 min. Two - three weeks after surgery, Doppler color ultrasound was reviewed. The stone clearance rate was 91.5% , and the ureteral stent was pulled out 4 -6 weeks later. Conclusions Rigid ureteroscopy and flexible ureteroscopy combine with holmium laser lithotripsy is a safe and effective on complicated upper ureter calculi, which has the advantages of small trauma and quick recovery.