组合式输尿管软镜钬激光碎石治疗上尿路结石的临床体会

Clinical effectiveness of modular flexibleureteroscope combined with Holmium laser for treatment of upperurinary calculi

探讨采用F8组合式输尿管软镜(MURF)联合钬激光碎石术处理上尿路结石的临床价值。2014年5月至2014年12月入选上尿路结石患者31例,男24例,女7例,年龄范围为19至71岁。其中近段输尿管结石5例;近段输尿管结石合并肾上、中及下盏结石各1例;上盏结石6例;中盏结石7例;下盏结石5例;肾盂结石7例。此外,左侧上尿路结石结石23例,右侧为8例。结石大小范围为1.0cm至2.0cm,平均(1.72±0.54)cm。脊麻或全麻下,取截石位,镜下寻见输尿管开口,置入斑马导丝,并沿导丝,推wolf输尿管硬镜(F8/9.8)入输尿管内,直达肾盂。镜下检查肾盏的大致分布后,退出输尿管硬镜,沿导丝置入输尿管管鞘(UAS cook F12/14),输尿管管鞘近端至肾盂输尿管连接部;沿输尿管管鞘置入组合式URDF,并入肾盂,寻找到结石后用200μm钬激光将结石击碎(激光功率在1.0J至2.0J范围,频率为10Hz至20Hz,将结石击碎为2mm至3mm颗粒,用套石篮将部分在4mm左右结石取出。术后常规留置F6号双J管3周,留置导尿1至2d。术后第1天行腹部平片检查。术后两周行B超检查。31例患者中有28例一次顺利置入UAS,3例留置双J管后2周顺利置入UAS。手术时间30min至80 min(平均40min)。碎石效果良好,一期碎石成功率74.19%(23/31),3例留置D-J管后二次软镜碎石成功,输尿管上段结石碎石成功率达100%(5/5),肾下盏结石碎石成功率40.00%(2/5)。采用F8组合式输尿答软镜处理上尿路结石安全、方便、疗效可靠,尤其在处理输尿管上段结石和肾孟及肾中盏、上盏结石上疗效显著。

To evaluate the clinical value of modular flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi. A total of 31 patients with upper urinary tract calculi were recruited in the present study.The diameter of the calculi ranged 1. 0- 2. 0cm. The patients were under general or spinal anaesthesia and at cutting stone position. After dilating the ureter,we inserted the guide wire under the vision of F8 / 9. 8 rigid ureteroscope,then F12 / 14 flexible ureteral access sheath. Finally,holmium laser lithotripsy was performed by F8. 0 'Polyscope'modular flexible ureteroscope. The power of the laser was. 0 J and frequency was 10-20 Hz. F6 d-J tube was regularly input for 4weeks post-operation. KUB was performed 1 day post-operation to detect the result of lithotropsy and the position of D-J tube,if more than 6 mm residual stone was detected,ESWI was performed. Lithotripsy was performed successfully in 23 patients( 23 / 31); the operation time was 25-75 min( averagely 38 min); and the bleeding in the operation was less. 6 patients had low fever post-operation; there were no ureteral perforation,high fever or septicaemia. The success rate of one-time lithotripsy was 74. 19%. F8 modular flexible urctcroscopc is safe is safe,convenient and effective for lithotripsy of the upper tract calculi,especially for upper modular urctcral,pelvis,middle calyx,upper calyx stones.