经尿道输尿管软镜钬激光碎石术治疗肾结石的临床观察  

Clinical effectiveness of flexible ureteroscopic holmium laser lithotripsy in the treatment of renal calculi

作　　者：谷现恩[1] 张军[1] 刘佳[1] 

机构地区：[1]北京市垂杨柳医院泌尿外科,北京100022

出　　处：《中国医刊》2015年第3期35-38,共4页Chinese Journal of Medicine

基　　金：北京市朝阳区科委科研基金

摘　　要：目的本文探讨输尿管软镜钬激光碎石术治疗肾结石的疗效及安全性。方法选取应用输尿管软镜钬激光碎石术治疗肾结石的患者52例,左肾结石27例,右肾结石25例,结石位于肾盂32例,肾中盏6例,下盏7例,多肾盏结石7例。结石直径12-28mm,平均16.2mm。术前常规留置输尿管支架2周。全身麻醉46例,腰硬联合麻醉6例。术后12周复查腹部平片和B超,评估排石效果。结果 52例一次碎石率100%,碎石时间30-62分钟,总手术时长60-120分钟。术后发生输尿管石街5例,其中结合体外碎石3例,2次输尿管镜取石1例,等待排石1例。高热2例,均抗感染控制。输尿管支架留置时间4-8周。12周复查结石排净率为96.2%（50/52）。未出现输尿管穿孔、出血、狭窄等并发症。结论经尿道输尿管软镜钬激光碎石术是处理肾盂肾盏内结石的一种安全有效的微创治疗方法。Objective To explore the therapeutic safety and effectiveness of flexible ureteroscopic holmium laser lith-otripsy in the treatment of renal calculi. Method Select application soft ureter mirror holmium laser lithotripsy for the treatment of kidney stones 52 cases patients, 27 cases of kidney stones, left right 25 cases of kidney stones, stones in 32 cases of the renal pelvis, 6 cases of calyx, under the lamp that 7 cases, 7 cases of renal calyx calculi. Stone of 12-28 mm in diameter, an average of 16. 2 mm. Preoperative routine indwelling ureteral stents for 2 weeks. 46 cases of general anesthesia, the waist hard joint anesthesia 6 cases. 12 weeks after surgery abdominal plain film and review of the ultrasound, assessment row stone effect. Result Lithotripsy was successful in 52 patients for the first time （100%） and the duration of the lithotripsy ranged between 30 and 62 min. The total surgery time ranged from 60 to 120 min. There were 5 patients with ureteral steinstrasse, 3 patients performed by extracorporeal shock wave lithotripsy, and one patient performed by ureteroscopic lithotripsy for second time. Two patients presented with a hyperpyrexia following the surgery and all were got anti-inflammatory treatment. Ureteral stents were typically in-dwelling for 4 to 8 weeks following the surgery. Following up for 12 weeks,the total evacuation rate of the calculi was 96. 2%（50/52）. No severe complications including ureteral perforation, bleeding and stenosis occurred. Con-clusion The flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi.

关 键 词：肾结石 输尿管软镜 碎石术 

分 类 号：R691.4[医药卫生—泌尿科学]