应用孙氏末段可弯硬性输尿管肾镜联合钬激光治疗肾和输尿管上段结石疗效观察  

Sun′s tip-flexible ureterorenoscopy combined with holmium laser lithotripsy in treatment of renal and upper ureteral calculi

作　　者：王磊[1] 马松[1] 张先云[1] 李乾[1] 姜福金[1] 

机构地区：[1]徐州医科大学附属淮安医院江苏省淮安市第二人民医院泌尿外科,江苏省淮安223002

出　　处：《中华全科医师杂志》2017年第5期381-384,共4页Chinese Journal of General Practitioners

摘　　要：目的 评价孙氏末段可弯硬性输尿管肾镜（简称孙氏镜）联合钬激光治疗上尿路结石的疗效、安全性.方法 回顾性分析我院2015年11月至2016年5月收治的48例孙氏镜钬激光治疗输尿管上段和肾结石患者的临床资料.48例中,男29例（60%）,女19例（40%）.输尿管上段结石31例（65%）,肾结石17例（35%）.患者年龄21～67（37.8±12.5）岁,结石大小0.8～2.1（1.4±0.6）cm.术中孙氏镜直视下以硬镜模式进入输尿管内,上行至肾盂输尿管交接处后,自末端伸出可弯曲的软性头端探查肾盂及肾盏,寻及结石后置入钬激光光纤粉碎结石.术后2 d行肾-输尿管-膀胱摄影（KUB）X线片检查了解碎石情况及双J管位置;术后4周行彩超或CT检查评估碎石效果.结果孙氏镜进镜成功率94%（45/48）,钬激光碎石成功率96%（43/45）,3例患者因输尿管膀胱开口处狭窄或输尿管扭曲无法进镜改为腹腔镜取石和经皮肾镜碎石.术后4周结石清除率87%（39/45）,所有患者未出现严重并发症.结论 孙氏镜联合钬激光治疗输尿管上段和肾结石具有较高的成功率和结石清除率,术后并发症发生率低.Objective To evaluate the efficacy and safety of Sun＆#39;s tip-flexible ureterorenoscopy （tf-URS） combined with holmium laser lithotripsy in treatment of renal and upper ureteral calculi.MethodsClinical data of 48 patients （29 males and 19 females） with renal and upper ureteral calculi treated by tf-URS with holmium laser lithotripsy in our hospital from November 2015 to May 2016 were retrospectively analyzed.Among 48 patients there were 29 males and 19 females with a mean age of （37.8＆#177;12.5） years （21-67）, including 31 cases of upper ureteral calculi and 17 cases of renal calculi with a mean stone size of （1.4＆#177;0.6） cm （0.8-2.1）.The tf-URS was advanced through the ureter under visual direction with ＂rigid mode＂.When the endoscope reached the ueteropelvic junction, the inner flexible part was extended out to explore the pelvicaliceal stones and then the holmium laser lithotripsy was performed.The therapeutic results were evaluated by KUB 2 days after operation and color ultrasonography or CT 4 weeks after operation.Results The success rate of insertion of tf-URS was 94% （45/48）.The calculi were detected in 45 cases, and laser lithotripsy succeeded in 43 cases （96%）.The rate of total stone clearance was 87% （39/45）.The procedure was transformed to laparoscopic or percutaneous nephrolithotomy （PCNL） in 3 patients with ureterostenosis or ureteral distortion.No serious complications occurred.Conclusion The tf-URS with holmium laser in the treatment of renal and upper ureteral calculi is safe,reliable and effective.

关 键 词：输尿管镜检查 输尿管结石 碎石术 激光 激光 钬 

分 类 号：R699[医药卫生—泌尿科学]