输尿管软镜下激光碎石术在上尿路结石治疗中的应用  

Application of Flexible Ureteroscopic Laser Lithotripsy in Treating Upper Urinary Tract Calculi

作　　者：陈文彬[1] 刘飞[1] 崔书平[1] 

机构地区：[1]解放军第260医院泌尿外科,河北石家庄050041

出　　处：《现代生物医学进展》2015年第8期1556-1558,1569,共4页Progress in Modern Biomedicine

摘　　要：随着医疗设备的日新月异,在众多医学领域中,微创技术正逐步取代传统的开放手术。输尿管软镜作为泌尿微创腔镜技术的重要组成,在泌尿外科疾病的诊断和治疗中发挥着越来越重要的作用。输尿管软镜下激光碎石术治疗上尿路结石具有创伤小、安全性高、疗效确切、病人恢复快、并发症少的优点,尤其适用于出血体质、过度肥胖、因解剖特点预期ESWL效果不佳、结石体积较小以及肾盏无明显积水的患者。钬激光的使用是此项技术得以广泛应用的重要因素。当激光光纤直径小于0.4 mm时,钬激光对组织损伤最小,激光可以很快被水吸收,这些特点可以保证结石被充分击碎。该方法治疗上尿路结石并发症低、结石排净率高,可以作为体外冲击波碎石失败和经皮肾镜碎石术后残留结石的治疗选择,为熟悉内镜操作并熟练掌握钬激光碎石技术的泌尿外科医师治疗上尿路结石提供了安全有效的方法。本文就输尿管软镜下激光碎石术治疗上尿路结石作了具体的整理与分析。With the development of the medical equipments, in many medical fields, minimally invasive technology is gradually replacing traditional open surgery. Flexible ureteroscopy as an important part of the urinary micro-traumatic techniques is playing a more and more important role in diagnosis and treatment of urinary diseases. Laser lithotripsy through flexible ureteroscope has high efficiency and low complications rate, and is an effective and safe treatment modality for calyceal calculi, especially for those with bleeding diatheses, morbid obesity, unfavorable anatomic factors related to ESWL and those with minor diameter and without significant hydronephrosis.The major factor that made possible the widespread use of flexible ureteroscopy lithotripsy was the introduction of the holmium laser as an energy source. This energy is rapidly absorbed by water and has minimal tissue effect when activated with a laser fiber tip 0.4 mm away. These qualities allow long periods of fragmentation that reduces stones to a very small size. It has high clearance rate of stones and less complication and morbidity, and it is a better option for managing ESWL failed and PCNL residual calculi.The combination of flexible ureteroscope with Ho： YAG laser can be used safely and effectively by skilled urologists who are familiar with standard endoscopic procedures and trained in the use of the holmium laser in strictly selected clinical situations. In this paper, we made concrete trim and analysis on the therapeutic effect of flexible ureteroscopic laser lithotripsy in the treatment of upper urinary tract calculi.

关 键 词：输尿管软镜 激光 碎石术 上尿路 结石 

分 类 号：R691.4[医药卫生—泌尿科学]