2μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石  

Two macron continuous wave laser and pneumatic lithotripsy treatment of ureteral calculus accompanied with granulation via ureteroscope

作　　者：庞栋[1] 贺兵[1] 贾永中 王华[1] 李玉柱[1] 肖序仁[1] 

机构地区：[1]武警总医院泌尿外科,北京100039

出　　处：《中华泌尿外科杂志》2010年第12期825-827,共3页Chinese Journal of Urology

摘　　要：目的 探讨输尿管镜下2μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石的安全性和有效性.方法 2007年6月至2010年3月收治肉芽包裹性输尿管结石38例.男20例,女18例.平均年龄47（21～76）岁.左侧17例,右侧21例.肾积水中度24例,重度14例.肾盂分离平均3.8（2.1～7.2）cm.输尿管硬镜下,先用2 μm激光汽化切除结石下方炎性肉芽,显露结石,再用EMS碎石清石系统碎石,统计分析碎石率、排石率和并发症.结果 原位碎石成功35例（92%）.碎石时间平均（23.0±6.5）min;术中出血量平均（7.0±4.5）ml;术后住院时间平均（5.2±0.6）d.2例结石上移至肾盂,留置支架管后辅以ESWL碎石,1例输尿管狭窄置镜失败改开放手术.术后1个月复查,结石排净32例（86%）,平均随访8（3～15）个月,未出现输尿管狭窄,尿路感染等并发症.结论 输尿管镜下2 μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石安全、高效,可作为这类病例的首选治疗手段.Objective To investigate the therapeutic effects, safety of ureteral calculus accom panied with granulation treated with pneumatic lithotripsy and two-macron laser via transurethral uret eroscopic. Methods From June 2007 to March 2010, 38 cases of ureteral calculus accompanied with granulation were treated with 2 μm laser and pneumatic lithotripsy via ureteroscope. All the patients had middle to severe hydronephrosis. The granulation under the calculus was vaporized with the 2 μm laser, and then the ureteral stone was fragmented with pneumatic lithotripsy. The clinical datum,stone disintegration rate, lithagogue rate and complication were retrospectively analyzed. Results Among 38 cases of ureteral stones, rate of successful fragmentation in a single procedure was 92%（35/38）. The operation time ranged from 15 to 45 min, mean （23.0±6.5）min. Estimated the intraoperative blood loss was （7.0±4.5）ml. The postoperative hospitalization time was （5.2±0.6）d. Two upper ureteral stones were pushed back to the renal pelvis and a conversion to extracorporeal shock wave lithotripsy （ESWL） was needed. The insertion of the ureteroscope was failed in 1 case who was accepted open operation finally. Among the 37 cases treated via ureteroscopy, stone clearance rate was about 86% after operation 1 month. Follow-up examinations for 3-15 months （mean 8 months）showed no ureteral stenosis or urinary infection. Conclusion 2 μm laser and pneumatic lithotripsyvia ureteroscope could be a highly effective and safe therapy for treatment of ureteral stone with granulation.

关 键 词：输尿管结石 2ΜM激光 

分 类 号：R686[医药卫生—骨科学]