经尿道输尿管镜钬激光碎石治疗急性肾后梗阻临床观察  

Transureteroscopic Holmium laser in the treatment of acute obstruction by ureteral calculus

作　　者：陈球[1] 李龙江[1] 

机构地区：[1]广东医学院附属深圳西乡人民医院泌尿外科,广东深圳518102

出　　处：《吉林医学》2011年第13期2515-2517,共3页Jilin Medical Journal

摘　　要：目的:探讨经尿道输尿管镜钬激光碎石取石解除输尿管结石嵌顿性急性梗阻的治疗方法。方法:对24例(26侧)结石嵌顿于输尿管导致持续性肾绞痛超过24 h、静脉尿路造影梗阻侧肾脏不显影、肾功能损害患者,经过必要的术前准备,急诊施行经尿道输尿管镜碎石取石、输尿管放置双J管内引流,及时解除梗阻,引流尿液,消除疼痛,挽救受损肾功能。结果:所有患者顺利接受手术,22侧中下段结石获得彻底粉碎;4侧输尿管上段结石中2例结石粉碎,2例术中较大碎石片被冲回肾内,3 d后行ES-WL治疗达到满意效果。术后患者疼痛消失、全身状况改善、肾功能快速恢复,感染等并发症得到及时控制,无肾积脓、肾功能丧失等严重并发症。14侧碎石术后2周内排净碎石;12侧术后1个月内排净碎石。3例急性肾功能不全患者血肌酐术后第2、4、7天降至正常。结论:急诊经尿道输尿管镜钬激光碎石取石术是一种便捷、安全、有效的治疗输尿管结石嵌顿性急性梗阻的方法。Objective To evaluate the treatment on acute obstruction of impacted ureteral calculus by transureteroscopic Holmium laser.Method For 24 cases（26 sides） of impacted ureteral calculus,with durative kidney angina for 24 h,with no pyelic imaging in travenous pyelogram in obstructed side and renal function damaged,were treated emergencily by ureteroscopic lithotomy and ureter catherizing after careful pre-operative preparing,in order to wipe off obstruction and pain,urinary drainage and save renal function.Results All patients successfully underwent the operation.For 22 sides mid and distal ureteral calculus were successfully treated.Two of 4 sides mid and upper ureteral calculus were successfully treated,and the other two sides were treated by ESWL after the stones moved up to kidneys in 3 days later.After operation,all patients′ pain disappeared,the conditions were improved,renal functions improved quickly,infections and other complications were controlled in time,and there was no serious complications,such as pyonephrosis and renal function loss.Fourteen cases with ureteral calculi were successfully treated 2 weeks later and 10 cases were successfully treated 1 month later.The blood creatinine of 3 cases became normal 2~7 days later.Conclusion Transureteroscopic Holmium laser is an effective,convenient and safe method in the treatment of impacted ureteral calculus.

关 键 词：输尿管镜 钬激光 尿路结石 

分 类 号：R699[医药卫生—泌尿科学]