输尿管镜钬激光技术治疗输尿管结石合并息肉(附75例报告)  

Ureteroscopic Holmium: YAG Laser Lithotripsy in the Management of Ureteral Calculi with Polyp: Report of 75 Cases

作　　者：袁武雄[1] 吴万瑞[1] 向明[1] 段义星[1] 刘哲[1] 

机构地区：[1]湖南省人民医院泌尿外科,长沙410005

出　　处：《中国微创外科杂志》2013年第8期705-707,共3页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨输尿管镜钬激光技术对输尿管结石合并息肉的治疗效果。方法 2007年9月～2012年4月,对75例输尿管结石合并息肉行输尿管镜钬激光治疗。结石位于输尿管上段18例,中段38例,下段19例;结石长径0.6～1.7 cm,平均1.1 cm。术中50例息肉未行任何处理,10例息肉仅限于结石表面烧灼,切除息肉15例并送病检。结果 69例一次碎石成功;3例结石上移至肾盂术后1周体外冲击波碎石治疗;2例输尿管上段扭曲折叠进镜失败改经皮肾镜术:1例术中输尿管穿孔出血改开放取石。手术时间20～95 min,平均43 min。术后住院时间2～10 d,平均5 d。67例术后随访6～12个月,B超或静脉肾盂造影检查64例肾积水消失,输尿管通畅,未见明显结石残留,3例输尿管狭窄,均为术中处理息肉者。结论输尿管镜钬激光技术治疗输尿管中下段结石合并息肉具有良好的疗效,不影响手术视野和碎石操作的息肉无需处理。Objective To explore the effect of ureteroscopic holmium： YAG laser lithotriptor in the treatment of ureteral calculi with polyp. Methods From September 2007 to April 2012, ureteroscopic holmium： YAG laser lithotripsy was performed on 75 patients presenting with ureteral stone with polyp. 18 cases had stones located in upper ureter, 38 cases in middle ureter,and 19 cases in lower ureter. Stone diameter ranged from 0.6 to 1.7 cm, with a mean of 1.1 cm. The polyps in 50 cases did not receive any treatment, the polyps of 10 cases received treatment limited to polyps burning on the stone surface, and the polyps of the other 15 eases were removed and sent for pathological examination. Results Of all the 75 cases, the lithotripsy was successful on 69 patients; 3 patients underwent ESWL one week after lithotripsy because of the stone slipping into renal pelvis; 2 patients with folded upper ureter were converted to PCNL after unsuccessful ureteroscopy insertion; 1 patient was converted to open surgery due to ureteral perforation. The mean operation time was 43 rain （20 -95 rain） , the mean hospital stay after surgery was 5 d （2 - 10 d）. A follow-up of 6 to 12 months of the 67 patients showed the following results： B ultrasonic or excretory urography showed 64 patients were asymptomatic and no obvious stone residue was found. 3 eases who received polyps treatment during operation presented with ureterostenosis. Conclusions Ureteroscopic holmium： YAG laser lithotripsy is a highly effective method for managing middle-lower ureteral calculi with polyp. No treatment is needed for the polyps which do not affect visual field and lithotripsy.

关 键 词：输尿管镜 输尿管结石 息肉 钬激光 

分 类 号：R693.4[医药卫生—泌尿科学]