一期行经尿道输尿管镜钬激光碎石取石术120例效果观察

Clinical experience of first-stage transurethral ureteroscopic holmium laser lithotripsy:a report of 120 cases

目的分析一期输尿管镜治疗患者120例的治疗效果。方法收集2016年7月一2018年8月一期接受输尿管镜(硬镜和软镜)碎石术治疗泌尿系结石120例患者的临床资料。统计一期失败后转二期的例数,失败原因,以及比较一期失败后二期手术的患者与一期成功的患者行输尿管镜碎石术的手术时间、术后平均住院日、残留结石发生率。结果120例患者中25例失败置输尿管支架管后2周行二期手术,2例输尿管损伤置输尿管支架管后1月行二期手术,93例一期取石成功。27例二期手术患者全部成功。一期转二期失败原因多见于输尿管狭窄(20例)、出血视野不清(3例)、输尿管走形迂曲伴结石肉芽包裹(2例)、输尿管损伤(2例)。对比93例一期手术患者与27例二期手术患者中在手术时间、平均住院日无显著差异,二期手术患者的残留结石发生率低于一期患者。结论输尿管镜手术一期失败原因多见于输尿管狭窄。输尿管镜碎石术前预置输尿管支架,有利于提高输尿管镜的手术成功率,降低残余结石发生率。

Objective To summarize the clinical experience of first-stage transurethral ureteroscopic holmium laser lithotripsy for urethral stones.Methods The clinical data of 120 patients with urethral stones treated by first-stage ureteroscopy (hard and soft) lithotripsy were collected to analyze\the number of failure of the first-stage lithotripsy,the cause of failure, and compare the operation time,average hospitalization day,and residual stone rate between the patients with successful first-stage ureteroscopy lithotripsy and those who had to indergo second-stage ureteroscopic lithotripsy after the first-stage failure.Results The first-stage ureteroscopy (hard and soft) lithotripsy was a success in 93 of the 120 patients. 25 of the 120 patients had to undergo a second-stage surgery 2 weeks after the ureteral stent implantation in the first-stage,2 of the 120 patients with their ureters injured during the first-stage treatment had to undergo a second-stage surgery 2 months later.All the 27 second-stage surgeries were successful.The reasons for the failure of the first-stage surgery included ureteral stricture (20 cases),vision blurred by bleeding (3 cases),Ureteral obstruction with stone granulation package(2 cases),and ureteral injury (2 cases).There were no significant differences in the operation time and hospitalization days between the 93 patients with successful first-stage surgery and the 27 patients who underwent secondstage surgery.The incidence of residual stones in the patients who underwent second-stage surgery was lower than that in the in the patients who only undergo first-stage treatment.Conclusion The commonest cause of failure of transurethral ureteroscopic holmium laser lithotripsy is abnormal ureteral stricture.Pre-positioning ureteral stents before ureteroscopic lithotripsy is beneficial to improve the success rate of ureteroscopy and reduce the incidence of residual stones.