镍钛合金取石网在41例输尿管上段结石钬激光碎石中的应用  

Application of Stone cone in 41 patients with upper ureteral calculi treated by ureteroscopic holmium laser lithotripsy

作　　者：刘洪宝 黄懿[2] 祝黎洁[2] 吴升[2] 糜远源[2] 邵洪宝 

机构地区：[1]无锡市宜兴红塔医院泌尿外科,江苏无锡214204 [2]无锡市第三人民医院泌尿外科,江苏无锡214041

出　　处：《现代泌尿外科杂志》2016年第9期703-704,716,共3页Journal of Modern Urology

摘　　要：目的探讨镍钛合金泌尿系统取石网（Stonecone）在输尿管镜下行输尿管上段结石钬激光碎石术中的临床应用价值。方法选取41例单侧输尿管上段结石合并轻中度肾积水患者，结石直径11-18mm，术中输尿管镜下见上段结石，击碎结石部分侧壁或直接通过该间隙置入Stonecone，予钬激光完全击碎结石。结果3例患者结石接近肾盂输尿管连接处，置入取石网时结石向上漂移入肾盂，遂留置D—J管后予以体外冲击波碎石处理。其余38例输尿管上段结石均置网顺利，术中以钬激光将结石击碎至粉末化，碎石成功率92．7％，手术操作时间为15-55min，平均（30±10）min，术后复查腹部卧位平片（KUB）或多排螺旋CT提示无明显结石残留。术中均无输尿管穿孔及黏膜剥脱等并发症发生。结论输尿管镜钬激光配合Stonecone是处理输尿管上段结石的安全有效的方法，能显著减少结石漂移并提高单次结石清除率。Objective To investigate the clinical value of Stone cone in ureteroscopic holmium laser lithotripsy for upper ureteral calculi. Methods A total of 41 patients with unilateral ureteral calculi and moderate hydronephrosis were selected. The diameter of stone was 11-18 ram. In the surgery, the stones were completely crushed by holmium laser with the aid of Stone cone which was placed through the gap beside the stones. Result Of all 41 cases, 38 had Stone cone successfully placed and stones were successfully crushed. The success rate was 92.7 %, operation time was 15-55 min, average （30 ± 10）min. Af- ter operation, KUB or CT showed no significant residual stones. In the other 3 cases, as the stones were located near the uret- eropelvic junction, they drifted into the pelvis when the Stone cone was placed. Therefore, extracorporeal shock wave litho- tripsy was adopted after the DJ tube was placed. No complications such as perforation and mucosal stripping of ureteral were observed. Conclusion Application of Stone cone in ureteroscopic holmium laser lithotripsy is safe and effective for the treat- ment of upper ureteral calculi, which can significantly reduce the drift of stones and improve the success rate of lithotripsy.

关 键 词：STONE CONE 输尿管上段结石 输尿管镜 钬激光 

分 类 号：R693.3[医药卫生—泌尿科学]