新型负压吸引输尿管镜钬激光碎石术治疗输尿管结石  

A novel negative pressure ureteroscopic holmium-YAG laser lithotripsy for ureteral stones

作　　者：吴中华 刘同族[1] 王行环[1] 王永志 胡东亮[1] 张卫兵[1] 张银高[1] 郑航[1] WU Zhonghua;LIU Tongzu;WANG Xinghuan;WANG Yongzhi;HU Dongliang;ZHANG Weibing;ZHANG Yingao;ZHENG Hang(Department of Urology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院泌尿外科,湖北武汉430071

出　　处：《现代泌尿外科杂志》2021年第6期529-531,共3页Journal of Modern Urology

基　　金：湖北省卫生健康委员会联合基金项目(No.WJ2019H057)。

摘　　要：目的介绍一种新型输尿管镜钬激光碎石术中使用的负压吸引装置,以弥补传统输尿管镜钬激光碎石术的不足。方法2018年12月至2019年6月,对75例单发、单侧、不透X线输尿管结石患者行新型负压吸引输尿管镜钬激光碎石术,结石长径10.3(5~18)mm,采用Wolf F8/9.8输尿管硬镜和新型负压吸引装置。该负压吸引装置由F5输尿管导管和三通接头组成。将200μm的钬激光光纤通过输尿管导管内腔进行碎石,并将三通接负压吸引管,术中持续灌注和负压吸引。结果75例患者手术均成功。无结石上移至肾脏,仅1例术后出现低热,给予敏感抗生素治疗后恢复正常。无输尿管穿孔、黏膜撕脱等严重并发症发生,无术中改行输尿管软镜碎石或经皮肾镜术(PCNL)者。术后第1天复查腹部X线片(KUB),结石清除率为97.33%(73/75),术后1个月结石清除率为100%。结论新型负压吸引输尿管镜钬激光碎石术安全、有效、易学,可防止结石上移,缩短手术时间,降低肾盂压力,提高结石清除率,减少并发症发生。Objective To introduce a negative pressure laser lithotripsy device to reduce retrograde migration and improve efficacy of the traditional procedure to treat ureteral stones.Methods From Dec.2018 to Jun.2019,75 patients with solitary radiopaque ureteral stones underwent retrograde ureteroscopy with a Wolf F8/9.8 rigid ureteroscope and the negative pressure device.The mean stone size was 10.3(5-18)mm,measured for the maximum length.The negative pressure laser lithotripsy device consisted of a F5 ureter catheter and a tee joint.The 200μm laser fiber was introduced into the ureteral catheter through the opening of the tee joint.The end of the tee branch was connected to the negative pressure pipe.Continuous perfusion and negative pressure suction were maintained during the operation.Results All operations were successful,with no observed stone migration.Low fever occurred in 1 case,who recovered after antibiotic therapy.No ureteral perforation,mucosal avulsion or other serious complications occurred.There was no need no convert to flexible ureteroscopic lithotripsy or percutaneous nephrolithotomy(PCNL).The stone-free rate was 97.33%(73/75),demonstrated on plain radiography of the kidney-ureter-bladder on the first postoperative day.The stone-free rate after one month was 100%.Conclusion The negative pressure ureteroscopic lithotripsy is simple and safe to manage ureteral stones.It can prevent stone retrograde migration,shorten operation time,decrease renal pelvic pressure,improve stone-free rate,and reduce incidence of complications.

关 键 词：输尿管结石 输尿管镜 负压吸引 钬激光 疗效 

分 类 号：R693.4[医药卫生—泌尿科学]