双频双脉冲激光碎石治疗输尿管结石的效果

Frequency-doubled-double-pulse laser lithotripsy of ureteral calculi

目的 探讨新型双频双脉冲激光治疗输尿管结石疗效。 方法 总结 15 0例输尿管镜下双频双脉冲激光碎石经验。男 94例 ,女 5 6例 ;平均年龄 4 2岁。结石位于输尿管上段 4 8例 ,中段35例 ,下段 6 4例。合并另一侧多枚结石者 3例。 结果 15 0例患者一次碎石成功 136例(90 .6 % ) ,1周结石排净 131例 (96 .3% )。上段碎石失败 9例中 ,二期行ESWL治疗 5例 ;输尿管成角扭曲改开放手术 2例 ,碎石中发生输尿管穿孔 2例。中下段失败 5例 ,其中碎石不完全 1例 ,尿酸性结石未能粉碎 1例 ,输尿管镜操作失败改开放手术 3例。患者术后均出现轻重不等的肉眼血尿。无发热 ,脓肾病例。平均手术时间 32min ,平均激光工作时间 3.3min。术后平均住院 2 .5d。 结论 双频双脉冲激光是一种功能单一、操作简单、安全、对软组织损伤小 ,碎石高效的激光。可作为输尿管结石不宜行ESWL治疗或ESWL治疗失败后的一种选择方法。

Objective To study and evaluate frequency-doubled-double-pulse laser (FREDDY) lithotripsy of ureteral calculi. Methods The experience of 150 cases of ureteral calculi treated with FREDDY from April to December in 2001 was summarized.94 are male patients and 56 female with an average age of 42.There were 48 cases of upper,35 middle and 64 lower ureteral stone. Results Of 150 cases,136(90.6%) were successful on the first lithotripsy.Of which in 131 cases (96.8%) the stone fragment completely expelled in one week.The procedure failed in 9 cases of upper ureteral calculi.Among them,5 cases was due to up drift of calculi or incomplete lithotripsy and was then shifted to ESWL therapy.2 was due to angular twist of the ureter and changed to open operation,and another 2 was due to perforation of ureter during the procedure.Of the 5 failed cases with middle and lower ureteral calculi,1 was due to incomplete lithotripsy,nonfragmentation in 1 case and failure of ureteroscopy in 3(changed to open operation).Different degree of hematuria was seen in every case after operation.High fever or pyonephrosis after operation has not been observed.The average operation time was 32 minutes,and the average time for laser working was 3.3 minutes.The average hospitalization after operation was 2.5 days. Conclusions FREDDY is a kind of laser with the characteristics of single function,simple operation,safe,less damage to the soft tissue and high efficiency of lithotripsy.The procedure is indicated if ESWL failed or not indicated.