输尿管软镜钬激光碎石术在上尿路结石治疗中的应用  

Application of Flexible ureteroscopy combined with holmium laser lithotripsy for upper urinary tract calculi

作　　者：邓汪东[1] 陈南辉[1] 陈智林[1] 孙忠凯[1] 黄志成[1] 彭栋[1] 

机构地区：[1]广东省梅州市人民医院泌尿外科,广东梅州514031

出　　处：《吉林医学》2016年第2期317-319,共3页Jilin Medical Journal

基　　金：广东省梅州市科技计划项目[项目编号:2013B11]

摘　　要：目的：探讨输尿管软镜钬激光碎石术治疗上尿路结石的临床疗效。方法：采用输尿管软镜钬激光碎石术治疗上尿路结石80例,共有结石115枚,结石大小0.6-2.2 cm,平均（1.19±0.25）cm。先用输尿管硬镜探查患侧输尿管,留置导丝,顺导丝置入输尿管扩张鞘,置入输尿管软镜找到结石,以200μm钬激光光纤、0.8-1.2 J/8-10 Hz功率碎石。常规留置5F DJ管。术后第一天复查KUB了解结石残留情况及DJ管位置。残石≤3 mm视为碎石成功。结果：输尿管扩张鞘一次置入率90.0%（72/80）,结石寻及率94.8%（109/115）,单次碎石成功率91.3%（105/115）。手术失败者2例为下盏结石,1例为中盏结石合并盏颈口明显狭窄,1例为输尿管结石合并中盏结石,输尿管碎石后尿色较红,终止手术。手术时间35-96 min,平均58 min,术后住院2-5 d,平均3.4 d。术后2-3 d拔除尿管,1个月拔除双J管。无输尿管穿孔、输尿管黏膜脱套、尿源性败血症等并发症。结论：输尿管软镜钬激光碎石术对肾盂结石、肾盏结石及输尿管上段结石安全有效。Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for upper urinary tract calculi. Method 80 cases of renal and upper ureter calculi（ sized between 6 to 22 mm in diameter,115 calculi in total） were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospital. The ureteral lumen was observed and dilated by a rigid ureteroscopy,then a ureteral access sheath was placed. Holmium laser lithotripsy was performed by a Wolf flexible ureteroscopy. The power of the laser was 0. 8 - 1. 2J /8 - 10 Hz. A F5 DJ stent was regularly input. KUB was performed 1 day post operation to detect the position of DJ stent and the result of lithotripsy. Lithotripsy was considered successful when the diameter of the residual calculi was not bigger than 3 mm. Results The insertion of flexible ureteroscopy was successful in 90. 0%（ 72 /80）in the first time. The calculi were detected in 94. 8%（ 109 /115）,and laser lithotripsy succeeded in 91. 3%（ 105 /115）. The average operation time was 58 minutes（ 35 - 96 min）. The average postoperative hospitalization was 3. 4 d（ 2 - 5 d）. No serious complication was observed. Conclusion Flexible ureteroscopy combined holmium laser lithotripsy is safe and effective for upper urinary tract calculi.

关 键 词：输尿管软镜 钬激光 碎石术 尿路结石 

分 类 号：R699[医药卫生—泌尿科学]