URL联合MPCNL双频双脉冲激光碎石术治疗ESWL后输尿管多发结石或石街并同侧肾结石  

Combination of URL and MPCNL with the Frequency - doubled - double Pulse Nd： YAG neodymium Laser in the treatment of ureteral calculi and renal stone after ESWL

作　　者：褚健[1] 郎根强[1] 章益峰[1] 庄剑秋[1] 曹建伟[1] 邓晓俊[1] 

机构地区：[1]中国人民解放军第411医院泌尿外科,上海200081

出　　处：《国际泌尿系统杂志》2012年第2期165-168,共4页International Journal of Urology and Nephrology

摘　　要：目的总结输尿管镜碎石术（URL）联合微创经皮肾镜（MPCNL）U-100双频双脉冲Nd：YAG激光碎石术治疗体外冲击波碎石术（ESWL）后输尿管多发结石或石街并一期处理同侧肾结石的经验。方法先对26例肾结石行体外冲击波碎石术后输尿管多发结石或石街并肾结石的患者先采用输尿管镜将结石推打至肾盂，再行微创经皮肾镜U-100双频双脉冲Nd：YAG激光碎石术，评价平均手术时间、估计出血量、残石率、手术并发症。结果26例患者均一次穿刺成功建立经皮肾通道。一期结石清除率为76．9％（20／26），二期碎石1例，3例残石大小0．5—1．2cm者辅以ESWL治疗，2例≤0．4cm者经体位排石等保守治疗排净。平均手术时间95win，手术出血量平均80mL。术后平均住院7．5d。结论输尿管镜结合微创经皮肾镜U-100双频双脉冲Nd：YAG激光治疗体外冲击波碎石术后输尿管多发结石或石街并同侧肾结石，不仅明显缩短手术时间、提高清石率、降低输尿管损伤，也可同期处理肾内结石，缩短治疗周期，是一种较好的手术方法。Objectives To evaluate the efficacy and safety of Ureteroseope Recessive Lithotrity （URL） combined with Minimally Invasive Percutaneous Nephrolithotomy （MPCNL） using the U - 100 Frequency - doubled - double Pulse Nd： YAG neodymium laser in the treatment of the simultaneous ipsilateral renal and ureteral calculi after extracorporeal shock wave lithotripsy （ESWL）. Methods 26 cases of ipsilateral renal and ureteral calculi treated with ESWL unsuccessfully were managed by URL with the U -100 Frequency- doubleddouble Pulse Nd： YAG neodymium laser first. The residual calculi in the renal pelvic were cleared by MPCNL simultaneously. The mean operative time, estimated blood loss, residual stone rate and perioperative complication were evaluated. Resuits 26 patients were successfully established a pereutaneous puncture channel. The stone - free rate after phase I operation was 76.9% （20/26）. Phase II lithotripsy was performed in 1 case. Three eases with residual stones af0. 5 - 1.2 cm received adjuvant extracorporeal shock wave lithotripsy while 2 eases with stones less than 0. 4 cm discharged stones completely after conservative therapy. The average operative time was 95 min. The average blood loss was 80 ml. The mean postoperative hospital stay was 7.5 days. Conclusions Ureteroscope Recessive Lithotrity combined with Minimally Invasive Pereutaneous Nephrolithotomy using U - 100 Frequency - doubled - double Pulse Nd： YAG laser is an alternative for the treatment of ipsilateral renal and ureteral calculi after unsuccessful extracorporeal shock wave lithotripsy, with the advantage of shortened operation time, increased stone clearance rate, minimal ureteral injuries and handling the renal stones in one stage.

关 键 词：输尿管结石 碎石术 激光 

分 类 号：R693.4[医药卫生—泌尿科学]