复杂性输尿管下段结石的内镜治疗  

URETEROSCOPIC HOLMIUM LASER LITHOTRIPSY FOR DISTAL URETERAL CALCULI CONCOMITANT WITH SECONDARY URETERAL LESIONS

作　　者：杨海帆[1] 陈昌志 李映川[1] 姜睿[1] 

机构地区：[1]泸州医学院附属医院泌尿外科,四川泸州646000 [2]四川省雅安技术学院

出　　处：《泸州医学院学报》2009年第2期147-149,共3页Journal of Luzhou Medical College

摘　　要：目的:探讨输尿管镜钬激光碎石术治疗伴有输尿管继发性病变的输尿管下段结石的疗效及适应症。方法:2003年2月至2006年4月共收治伴有输尿管继发性病变的输尿管下段结石23例,钬激光碎石的同时处理炎性肉芽、息肉或环形输尿管管腔狭窄等输尿管继发性改变。结果:23例患者19例术后3月时结石已排净,一次性成功率为82.6%。4例结石碎片嵌顿于原结石梗阻部位,需要再次输尿管镜手术处理。2例术后原结石梗阻部位输尿管进行性狭窄,改行开放手术。输尿管结石复发3例,经ESWL处理后结石排净。结论:输尿管镜钬激光碎石术可以有效治疗大多数合并输尿管继发性病变的输尿管下段结石,术后应重视定期随访。如果结石嵌顿部位炎性肉芽和息肉病变严重、重度输尿管管腔狭窄或合并严重的上尿路感染时应考虑改行开放手术。Objective：To discuss the therapeutic efficacy and indication of ureteroscopic Holmium laser lithotripsy for distal ureteral calculi concomitant with secondary ureteral lesions. Methods：From Feb 2003 to Apr 2006, total of 23 patients diagnosed as distal ureteral calculi with secondary ureteral lesions were managed by ureteroscopic Holmium laser lithotripsy. Retrospective study was conducted on the clinical outcomes. Results： The stones were fragmented and cleared completely by single ureteroscopic procedure in 19 cases. Residual calculi were demonstrated in 4 cases and ultimately cured by additional ureteroscopic operation. Follow-up time was between 7 months and 3 years. 2 patients suffered from gradually deteriorated ureteral stricture after operation and received open surgical ureteroplasty. ESWL therapy was required in 3 cases because of stones recurrence. Conclusion：Ureteroscopic Holmium laser lithotripsy could treat most of the distal ureteral calculi with secondary ureteral lesions effectively. However, periodic watchful following-up is necessary for early management of possible ureteral stricture and stones recurrence. For those with serious secondary ureteral lesions, including serious inflammatory granulation and polyp, ureteral stricture or upper urinary infection, it＇s advisable to convert to open surgical treatment.

关 键 词：输尿管下段结石 内镜手术 治疗 

分 类 号：R693.4[医药卫生—泌尿科学]