输尿管镜钬激光碎石术治疗输尿管结石72例报告  

Ureteroscopic holmium laser lithotripsy for ureteral calculus: Report of 72 cases

作　　者：刘荣福[1] 邢金春[1] 陈斌[1] 陈实新[1] 王惠强[1] 叶友新[1] 庄炫[1] 张开颜[1] 杨宇峰[1] 周中泉[1] 徐胤华[1] 周鑫[1] 

机构地区：[1]福建医科大学附属厦门第一医院泌尿外科,厦门361003

出　　处：《中国微创外科杂志》2007年第3期255-256,共2页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨钬激光联合输尿管镜技术治疗输尿管结石的临床效果。方法2004年4-11月采用美国科医人公司LUMENIS POWER Suite 100 W钬激光及Circom MRO输尿管镜对72例输尿管结石进行碎石治疗。经尿道输尿管镜直视下到达结石部位,采用钬激光腔内碎石治疗。结果手术时间14-83 min,平均28 min。3例失败由于位于输尿管上段的结石移至肾脏,一次碎石成功率95.8%(69/72),其中上段结石成功率92.1%(35/38)、中下段结石成功率100%(34/34)。术中输尿管穿孔3例(4.2%)、结石移动9例(12.5%)、血尿72例(100%);术后腰痛45例(62.5%)、血尿72例(100%)、泌尿系感染5例(6.9%),无输尿管狭窄发生。术后第1天KUB检查无结石率86.1%(62/72),余7例均于2周内排净。术后住院2-5 d,平均3 d。49例术后3个月复查B超或静脉尿路造影,均未发现输尿管狭窄,28例肾积水减轻(1.4±0.5)cm、21例肾积水消失。结论钬激光联合输尿管镜技术治疗输尿管结石临床疗效好、并发症少。Objective To investigate the clinical effect of ureteroscopic holmium laser lithotripsy for the treatment of ureteral calculus.Methods A total of 72 cases of ureteral calculus was treated with stone fragmentation from April to November 2004,by using the Lumenis VersaPulse PowerSuite 100W Holmium Laser system and the Circon ACMI Micro Ureteroscope.Under ureteroscopic visualization,the laser lithotrite was introduced to the stones,and holmium laser intraluminal stone fragmentation was carried out. Results The operation time was 14~83 min(mean,28 min).Three cases of fragmentation failure were due to upper ureteral stones migrating to the renal pelvis.The success rate of fragmentation on one session was 95.8%(69/72),which was 92.1%(35/38) for upper segment calculi and 100%(34/34) for middle-to-lower segment calculi.Intraoperative complications included 3 cases of ureteral perforation(4.2%),9 cases of stone migration(12.5%),and 72 cases of hematuria(100%).Postoperative complications included 45 cases of lumbago(62.5%),72 cases of hematuria(100%),and 5 cases of urinary tract infection(6.9%), without ureteral stricture.The kidney,ureter,and bladder(KUB) X-ray radiograph on the first postoperative day showed a stone-free rate of 86.1%(62/72),and the remaining residual stones were thoroughly expelled within following 2 weeks.The length of postoperative hospital stay was 2~5 d(mean,3 d).Re-examinations with B-ultrasonography or intravenous urography(IVU) at 3 months after operation in 46 cases revealed no ureteral stricture.Hydronephrosis subsided by 1.4±0.5 cm in 28 cases and completely disappeared in 21 cases.Conclusions Ureteroscopic holmium laser lithotripsy for treating ureteral calculus offers satisfactory clinical effects and low complication rates.

关 键 词：输尿管结石 钬激光 腔内治疗 输尿管镜 

分 类 号：R693.4[医药卫生—泌尿科学]