输尿管镜钬激光治疗输尿管结石伴息肉35例报告  

Ureteroscopic Holmium Laser Lithotripsy for the Treatment of Ureteral Calculi Complicated with Polyps（Report of 35 Cases）

作　　者：施华娟[1] 耿和[1] 

机构地区：[1]上海市普陀区人民医院泌尿外科,上海200060

出　　处：《医学临床研究》2013年第1期20-22,共3页Journal of Clinical Research

基　　金：上海市卫生局青年科研项目（20114Y134）

摘　　要：【目的】总结输尿管镜钬激光治疗输尿管结石伴息肉的疗效和操作技巧。【方法】回顾性分析采用钬激光经输尿管镜治疗35例输尿管结石伴息肉患者的临床资料。【结果135例患者1次碎石成功率为85．7％（30／35），1次输尿管息肉切除成功率100％，平均手术时间（42±5．3）min，术后平均住院（4±1．2）d。上段结石治愈14例，中段结石治愈6例，下段结石治愈10例，成功率分别为77．8％（14／18）、85．7％（6／7）和100．0％（10／10）。在碎石过程中，4例输尿管上段结石因术中切割息肉过程中结石碎片上移至肾孟，术后行体外冲击波碎石术（ESWL）。1例输尿管中段结石有长径约0．6cm碎片，拔除DJ管后自行排出。并发症发生率为5．71％（2／35）。35例患者术后拔除I）_J管后随访3个月至1．5年，腹部平片（KUB）显示结石均已排净；B超显示24例肾积水消失，另11例患者肾积水均有不同程度减轻。1例患者息肉伴结石于术后11个月后复发，再次行输尿管钬激光治疗。【结论】对于输尿管结石伴息肉患者，采用输尿管镜下钬激光切除息肉和碎石，可以达到满意的治疗效果。[Objective]To summarize the efficacy and operation skill of ureteroscopic holmium laser litho tripsy for the treatment of ureteral calculi with polyps. [Methods] Clinical data of 35 cases of ureteral calculi with polyps treated by ureteroscopic holmium laser lithotripsy were analyzed retrospectively. [Results]The successful rate of one-time laser lithotripsy for 35 patients was 85.7% （30/35）, and the successful rate of one- time ureteral polyp resection was 100% （35/35）. The mean operation time was （42! 5.3）min. The mean hos- pital stay was 4±1.2 days. There were 14 cases of upper ureteral calculi, 6 cases of medial utreteral calculi and 10 cases of lower uteteral calculi who were cured, and the successful rate of laser lithotripsy for upper, medial and lower ureteral calculi were 77.8 ~ （14/18） , 85. ？ ~ （6/7） and 100.0 ~ （10/10） , respectively. Four patients underwent extracorporeal shockwave lithotripsy（ESWL） due to the stone piece of 4 patients with me- dial ureteral calculi moving up to renal pelvis during the incision of polyps. The piece with 0.6cm diameter in a patient with medial ureteral calculi was discharged after the withdrawal of D-J tube. The incidence of complica- tions was 5.71%（2/35）. All 35 patients were followed up for 3 months to 1.5 years after the withdrawal of D- J tube. KUB showed that all stones were cleared. B-ultrasound showed that hydronephrosis in 24 patients dis- appeared, and that in other 11 patients was alleviated in different extent. One case of polyps with calculi re- curred 11 months after operation, and received ureteroscopic holmium laser lithotripsy again. [Conclusion] Ureteroscopic holmium laser for the polyp resection and lithotripsy for the treatment of patients with ureteral calculi and polyps can achieve the satisfactory effect.

关 键 词：输尿管结石 并发症 息肉 治疗 输尿管镜检查 钬 激光 

分 类 号：R693.4[医药卫生—泌尿科学]