U-100双频激光治疗尿路结石  

Ureterorenoscopic lithotripsy with Laser U-100 for the treatment of urinary calculi (report of 162 cases)

作　　者：杜小文[1] 舒耀民 戴国平[1] 朱永锋[1] 吴慧玲[1] 张春霆[1] 钱松溪[2] 

机构地区：[1]浙江省金华市人民医院泌尿外科,321000 [2]第二军医大学长海医院泌尿外科

出　　处：《中华泌尿外科杂志》2006年第3期197-199,共3页Chinese Journal of Urology

摘　　要：目的探讨U-100双频激光碎石治疗尿路结石的有效性和安全性及提高输尿管上段结石碎石效果的新方法。方法U-100双频激光治疗尿路结石162例，男97例，女65例，年龄19—82岁，平均41岁。其中尿道结石7例，膀胱结石26例，输尿管下段结石45例，中段32例，上段38例，肾结石14例。其中双侧尿路结石11例，单侧多发性结石7例，合并中、重度肾积水89例，IVU不显影17例，既往行体外冲击波碎石术（ESWL）32例，结石包裹、输尿管远端狭窄25例，合并尿路感染9例，以往有开放手术史13例，急诊碎石12例，同时行经尿道前列腺电切术（TURP）18例。结石直径4—50mm，平均12mm。U-100双频激光碎石机光纤730μm，激光能量120mJ，频率5—10H2，脉冲36—21500∑，平均1300∑。将结石粉碎至直径1—2mm为成功标准。结果本组碎石成功率94．4％（153／162），2例膀胱多发结石者碎石不易中转开放手术，3例输尿管上段结石上移滑入扩张肾盂者改行ESWL治疗，3例因输尿管穿孔或内膜撕脱中转开放手术，1例经皮肾镜致肾脏大出血而终止碎石。33例输尿管上段结石采用输尿管气囊导管阻断输尿管腔，激光碎石成功率为93．9％（31／33）。1—3个月结石排净率为98．7％（151／153），1例输尿管结石合并狭窄者有“石街”形成，需再次输尿管扩张、补充激光碎石，另1例肾盂结石者有多量小结石残留于肾下盏。结论U-100双频激光碎石术治疗尿路结石疗效好，安全。输尿管气囊导管阻断输尿管腔可提高输尿管上段结石激光碎石成功率。Objective To evaluate the efficacy and safety of lithotripsy with W. O. M. Laser U-100 in the treatment of urinary tract calculi,and to introduce a new method of improving lithotripsy efficiency of upper ureteral calculi. Methods The data of 162 patients （97 males and 65 females;age range,19 - 82 years;mean age ,41 years） who underwent lithotripsy with W. O. M. Laser U-100 （optical fiber 730μm,laser energy 120 mJ,frequency 5 - 10 Hz,pulse 36 - 21500 ∑,average 1300 ∑） were reviewed. Of the 162 patients,7 cases had urethral stones ;26, bladder stones ; 115, ureter calculi （ 38 upper, 32 middle, 45 lower） ; and 14,kidney stones. Among them, bilateral urinary stones occurred in 11 cases;unilateral multiple stones in 7 ;complicated moderate/severe hydronephrosis in 89 ; no image on IVU in 17 ; previous ESWL in 32 ; encapsulated stones and stricture of distal ureter in 25 ; complicated urinary infection in 9 ; previous open surgery in 13 ;emergent lithotripsy in 12 ;TURP simultaneously in 18. The size of the stones varied from 4 mm to 50 mm in diameter,with a mean of 12 mm. The success criterion of lithotripsy was defined as the fragmented stones of 1 - 2 mm in diameter. Results The success rate of lithotripsy for urinary tract stones with W. O. M. Laser U-100 was 94.4% （153/162）. In the remaining cases,3 were transferred to ESWL therapy due to up-drift of calculi,2 experienced conversion to open surgery due to multiple stones of the bladder,and 3 also had conversion to open surgery due to ureteral perforation or ureteral mucosa avulsion during the procedure, and l had to terminate the operation due to massive hemorrhage during percutaneous nephrolithotomy. The success rate of lithotripsy for upper urinary tract stones through the blocked ureteral balloon catheter was 93. 9% （31/33）. Of the 153 cases, 151 （98.7%） removed the fragmented atones completely within 1 -3 months. One case of ureteral stricture with steinstrasse underwent transureteroscopic laser lithotripsy successfully. One case

关 键 词：碎石术 激光 输尿管肾镜 尿路结石 输尿管气囊导管 

分 类 号：R691[医药卫生—泌尿科学]