输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石(附15例报告)  

Management of Proximal Ureteral Calculi after Failed ESWL with Holmium Laser Lithotripsy Through Flexible Ureteroscope (Report of 15 Cases)

作　　者：尉春晓[1] 陈修德[1] 张安学[1] 张建军[1] 于江[1] 金讯波[1] 

机构地区：[1]山东大学附属省立医院泌尿微创中心,山东济南250014

出　　处：《泌尿外科杂志（电子版）》2012年第3期13-16,共4页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的介绍输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石的临床经验。方法回顾性分析2011年9月至2012年8月收治的15例曾行ESWL治疗但未能成功排石的输尿管上段结石患者的临床资料。对所有患者均补救输尿管软镜钬激光碎石术,术后辅以抗炎排石治疗。结果所有患者均顺利完成手术,手术时间为65±20分钟,术中合并输尿管炎性息肉6例,均采用钬激光切除,无输尿管穿孔、大出血等并发症发生。术后导尿管留置时间为4±2天,1例患者出现寒战、高热,血培养提示大肠埃希菌感染,经亚胺培南西司他丁钠(泰能)治疗后症状消失。术后1个月复查KUB平片或B超示结石清除率为100%。结论输尿管软镜钬激光碎石术治疗ESWL失败后的输尿管上段结石有效,结石清除率高,可作为输尿管上段结石ESWL失败后的一种有效补救性治疗措施之一。Objective To report our experience in the treatment of proximal ureteral calculi after failed ESWL with holmium laser lithotripsy through flexible ureteroscope. Methods The data of 15 cases after failed ESWL between September 2011 and August 2012 were retrospectively analyzed. All the patients were treated with holmium laser lithotripsy through flexible ureteroscope, and adjunct drug therapy was used postoperatively. Results All operations were successful and the operation time was 65±20 min. Ureteral polyps were observed in 6 patients, which were resected by holmium laser lithotriptor through flexible ureteroscope. There was no ureteral perforation or huge bleeding occurrig during the operation. 1 patient suffered from shivering and high fever postoperatively and E. coli was detected by blood culture, who was successfully treated. The stone clearance was 100%. Conclusions Holmium laser lithotripsy through flexible ureteroscope is safe and effective for the treatment of proximal ureteral calculi after failed ESWL, which is worth using widely.

关 键 词：输尿管上段结石 输尿管软镜 钬激光 碎石 

分 类 号：R699[医药卫生—泌尿科学]