输尿管肾镜钬激光碎石术治疗输尿管结石  

Ureteropyeloscopy and holmium:YAG laser lithotripsy for treatment of ureteral calculi

作　　者：吴忠[1] 丁强[1] 姜昊文[1] 周守静[2] 郑景存[1] 杨醌[1] 赵鸿[1] 张元芳[1] 

机构地区：[1]复旦大学华山医院泌尿外科,上海200040 [2]复旦大学华山医院麻醉科,上海200040

出　　处：《中华泌尿外科杂志》2005年第1期27-29,共3页Chinese Journal of Urology

摘　　要：目的　探讨输尿管肾镜钬激光碎石术治疗输尿管结石的有效性和安全性。　方法　回顾性分析 186例应用半硬性输尿管肾镜和钬激光碎石术治疗的输尿管结石患者资料。男 12 3例 ,女 6 3例 ;平均年龄 5 1岁。上段结石 5 1例 ,中段 6 4例 ,下段 71例。结石直径 0 .6～ 2 .5cm ,平均 1.3cm。　结果　单次碎石成功率为 96 % (179/ 186 ) ,其中上段结石单次碎石成功率为 90 % (46 / 5 1) ,中、下段为99 % (133/ 135 )。平均手术时间 2 8min ,术中无输尿管穿孔等并发症发生。 179例术后平均住院 1.2d。术后随访 2周～ 3个月 ,结石排净率 99% (177/ 179) ,肾盂积水由术前 (3.6± 0 .7)cm降至 (1.5± 0 .4 )cm(P <0 .0 1) ,无输尿管狭窄发生。　结论　输尿管肾镜钬激光碎石术治疗输尿管结石高效、安全 ,可作为输尿管结石特别是中下段结石首选的治疗方法。Objective To evaluate the efficacy and safety of ureteropyeloscopic lithotripsy with holmium:YAG laser for treatment of ureteral calculi. Methods We retrospectively reviewed the data of 186 patients (123 males and 63 females,with an average age of 51 years) who underwent ureteropyeloscopic lithotripsy using holmium:YAG laser with a semi rigid ureteropyeloscope. Among these patients,51 had stones in the upper,64 in the middle,and 71 in the lower ureter.The stones were 0.6 to 2.5 cm (mean 1.3 cm) in diameter. Results The success rates of fragmentation in a single procedure for the upper and mid lower levels of ureteral stones were 90% (46/51) and 99% (133/135), respectively.The overall rate of successful fragmentation for all levels of ureteral stones in a single procedure achieved 96% (179/186).The mean operative time was 28 min,and the mean postoperative hospital stay was 1.2 days.No complications such as perforation occurred during the operation.In 179 patients,the postoperative follow up of 2 weeks to 3 months revealed that the stone free rate was 99% (177/179) and the hydronephrosis was markedly improved from preoperative (3.6±0.7) cm to postoperative (1.5±0.4) cm according to B ultrasound,IVU or renogram ( P <0.01).No ureteral stenosis occurred. Conclusions Ureteropyeloscopy and holmium:YAG laser lithotripsy is a highly effective and safe therapy for patients with ureteral calculi.It can be considered as a first choice of treatment,especially for those with middle or lower levels of ureteral stones.

关 键 词：输尿管肾镜 钬激光碎石术 治疗 输尿管结石 

分 类 号：R699[医药卫生—泌尿科学]