头低斜仰截石位在输尿管硬镜钬激光碎石术治疗输尿管上段结石:246例病例系列报告  

Effect of head-down inclined position in the treatment of upper ureteral calculi with holmium laser ureterscopic lithotripsy:a case series of 246 patients

作　　者：孟祥运 祝子清 郑新民[2] 伍庄 Xiang-Yun MENG;Zi-Qing ZHU;Xin-Min ZHENG;Zhuang WU(Department of Urology,Huainan Xinkang Hospital,Huainan 232007,Anhui Province,China;Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Urology,Wugang Hospital Group,Wuhan 430080,China)

机构地区：[1]淮南新康医院泌尿外科,安徽淮南232007 [2]武汉大学中南医院泌尿外科,武汉430071 [3]华润武钢总医院泌尿外科,武汉430080

出　　处：《医学新知》2020年第6期471-475,共5页New Medicine

基　　金：湖北省卫生健康委员会创新团队项目(WJ2017C0004)。

摘　　要：目的探讨头低斜仰截石位在输尿管硬镜钬激光碎石术治疗输尿管上段结石中的疗效。方法收集2016年4月至2019年12月采用头低斜仰截石位输尿管硬镜钬激光碎石术治疗输尿管上段结石246例的临床资料,分析其治疗效果。结果246例中98例次术中结石上移至肾盂或上组肾盏,输尿管硬镜追至肾盂或上组肾盏用激光将结石粉碎。240例一期碎石,成功率为97.6%。4例合并输尿管上段狭窄,留置DJ管2周后行输尿管软镜钬激光碎石成功。1例部分结石上移进入中组内侧肾盏,后期行体外冲击波碎石成功。1例结石上移进入上组肾盏,结石残片约0.6 cm。26例合并双侧输尿管结石,一期同时行双侧输尿管硬镜钬激光碎石术成功。手术时间15-56(26.08±11.73)min;住院时间4-6 d。结论头低斜仰截石位在输尿管硬镜钬激光碎石术治疗输尿管上段结石过程中安全有效,一期碎石成功率较高,建议采用高质量对照研究对本研究结果进一步验证。Objective To investigate the curative effect of head-down incline in holmium laser ureterscopic lithotripsy for upper ureteral calculi.Methods Clinical data was collected of patients who were diagnosed upper ureteral calculiand treated with holmium laser ureterscopic lithotripsyin head-down inclined position from April 2016 to December 2019.The effect of holmium laser ureterscopic lithotripsy in patients with upper ureteral calculi was evaluated.Results Finally 246 patients with upper ureteral calculi treated with ureteroscope holmium laser lithotripsy were included.Of them,98 cases of intraoperative stones moved up into the renal pelvis or upper group of calyces,ureteroscope was chased to the renal pelvis or upper group of calyces,and the stones were smashed with laser.240 patients had primary crushed stones with a success rate of 97.6%.4 patients with upper ureteral stenosis were successfully treated with ureteroscopic holmium laser lithotripsy after indwelling the DJ tube for two weeks.In one patient,some of the stones moved upward into the medial renal calyx of the middle group,and the extracorporeal shock wave lithotripsy was successful in the later stage.One patient's stones moved up into the upper group of calyces,and the stone fragments were about 0.6 cm.Twenty-six patients with bilateral ureteral calculi were successfully treated with bilateral ureteral holmium laser lithotripsy at the same time.The operation time was 15-56 min,with an average of 26.08±11.73 min;the length of hospitalization is 4-6 days.Conclusion The headdown inclined position is safe and effective in the treatment of upper ureteral calculi byholmium laser ureterscopic lithotripsy,and the success rate of first-stage lithotripsy is high.However,we suggest performing high quality controlled studies to verify.

关 键 词：头低斜仰截石位 输尿管硬镜钬激光 输尿管上段结石 

分 类 号：R699.4[医药卫生—泌尿科学]