输尿管软镜结合钬激光治疗肾结石的疗效观察  

Efficacy of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy for Renal Stones

作　　者：刘齐贵[1] 张文滔[1] 段娟[1] 周庆余[1] 赵谦[1] 曹伟[1] 王跃力[1] 姚建忠[1] 窦坤[1] 刘茜[1] 田成[1] 李坤林[1] 

机构地区：[1]解放军昆明总医院泌尿外科,昆明650032

出　　处：《中国微创外科杂志》2012年第3期239-241,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨输尿管软镜结合钬激光治疗肾结石的疗效。方法 2004年8月～2010年12月,采用输尿管软镜结合钬激光治疗肾结石475例,结石大小0.7～3.0 cm,平均1.4 cm。逆行输尿管软镜下经输尿管硬镜扩张输尿管后,留置输尿管推送鞘,使用200μm光纤行钬激光碎石,钬激光功率0.5～1.0 J/20～40 Hz。结果结石寻及率98.3%(467/475),一次手术碎石成功率97.5%(463/475)。手术时间5～60 min,平均25 min。住院时间1～4 d,平均3 d。发生败血症感染性休克4例,钬激光误伤肾盏致出血8例。留置双J管2～4周,拔管时复查B超,90.6%(423/467)排净结石,术后5周98.3%(459/467)结石排净。结论输尿管软镜下钬激光治疗肾结石微创,安全,疗效确切,并发症少,特别适用于结石较小的患者。Objective To evaluate the therapeutic effect of flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal calculi. Methods From August 2004 to December 2010,we used holmium laser and flexible ureteroscope to treat 475 cases of renal calculi.The diameter of the stones ranged from 0.7-3.0 cm with a mean of 1.4 cm.After the ureter was dilated,the stones were fragmentized and removed by using 200-μm Ho：YAG laser（0.5-1.0 J/20-40 Hz）.Results The detection rate and one-session success rate was 98.3%（467/475） and 97.5%（463/475） in our patients.The operation time ranged from 5 to 60 min with a mean of 25 min.The mean hospital stay of the patients was 3 days（1-4 days）.After the operation,4 patients developed septic shock,and 8 patients suffered from holmium laser-caused calyceal hemorrhage.A double-J tube was removed in 2-4 weeks,B-ultrasonography at the removal showed a renal stone clearance rate of 90.6%（423/467）,and then 98.3%（459/467） in 5 weeks after the operation. Conclusion Holmium laser lithotripsy through a flexible ureteroscope is a safe,minimally invasive,and effective treatment for renal calculi especially for patients with minor stones.

关 键 词：输尿管软镜 钬激光 肾结石 

分 类 号：R699[医药卫生—泌尿科学]