输尿管软镜钬激光碎石术治疗肾结石25例  

Flexible Ureteroscope and Holmium Laser Lithotripsy for Renal Calculi: a report of 25 cases

作　　者：吴强[1] 左自立[1] 辛彩霞[1] 程勇[2] 韩德军[1] 张子江[1] 

机构地区：[1]仁寿县人民医院泌尿外科呼吸内科,四川仁寿620500 [2]泸州医学院附属医院泌尿外科,四川泸州646000

出　　处：《四川医学》2014年第8期947-949,共3页Sichuan Medical Journal

基　　金：四川省卫生厅科研课题(编号:130544);眉山市科技计划项目

摘　　要：目的评价输尿管软镜结合钬激光治疗肾结石的有效性、安全性,分析影响输尿管软镜碎石成功率的影响因素。方法回顾分析2013年5月至2014年1月采用输尿管软镜下钬激光碎石术治疗肾结石25例,结石直径8~15mm,平均12mm。结石位于肾盂7例,中盏7例,下盏11例。术前留置J管2周,输尿管软镜寻及结石后,使用200μm钬激光光纤碎石。术后8周复查KUB,评估结石排净率。结果 24例顺利寻及结石（96.0%24/25）,一次碎石成功88.0%（22/25）,术后8周复查总结石排净率92.0%（23/25）,手术时间平均65 min（40~130min）,住院时间平均6d（5~7d）,无输尿管穿孔、撕脱及大出血等严重并发症。结论输尿管软镜结合钬激光是处理直径〈15mm肾结石的安全有效的手段。肾中盏及肾盂内结石较肾下盏结石碎石成功率高、结石排净率高。Objective To evaluate the efficacy and safety of flexible ureteroscope combined with Holmium laser for treatment of renal calculi, and to analyze the influencing factors of the success rate of lithotripsy. Methods We retrospectively reviewed the date of 25 patients from May 2013 to January 2014 who underwent flexible ureteroscopie Holmium laser Lithotripsy. The diameter of the stones ranged form 8mm to 15ram with a mean of 12mm. Amongthe cases,the calculi were located at the renal pelvis in 7 patients, at the middle calyx in 7, at the lower calyx in 11. A pig-tail stent would be set at the beginning of the procedure for 2 weeks. The stones were fragmentized by using 200μm Holmium Laser fiber. A follow-up by KUB was done 8 weeks after the procedure to evaluated the result of endoscopiec nephrolithotripsy. Results The calculi were detected in 24 patients（96. 0% ,24/ 25 ） , The success rate in a single procedure was 88.0% （ 22/25 ） , After 8 weeks, the total evacuation rate of the calculi was 92. 0% （23/25） o The mean operative time was 65 min（40 - 130min）, and mean hospital stay was 6d （5 -7d）. No serious complications were found, such as ureter perforation, avnlsion and hemorrhage. Conclusion The flexible ureteroscope and Holmium laser lithotripsy is safe and effective for renal calculi sized less than 15 mm in diameter, especially for those in the middle poles and renal pelvis.

关 键 词：输尿管软镜 肾结石 钬激光 

分 类 号：R699[医药卫生—泌尿科学]