摘要
目的:探讨输尿管镜钬激光碎石治疗嵌顿输尿管结石的有效性和安全性。方法:分析2005年10月～2008年5月输尿管镜下钬激光碎石治疗嵌顿输尿管结石268例患者临床资料,对碎石率、排石率和并发症等进行统计分析。结果:共行272例次输尿管镜钬激光碎石,一次碎石成功率为92.6%(252/272),输尿管上段与中、下段结石一次碎石成功率分别为84.6%(66/78)、95.9%(186/194);平均手术时间35min,平均碎石时间16min;结石移位改行ESWL8例,结石位置较高改行微创经皮肾镜取石9例,改开放手术取石3例;碎石过程中黏膜撕裂4例、黏膜下假道形成6例,输尿管穿孔4例;18例术后发热(体温>38.5℃,持续2天以上),5例出现体温>39℃,其中1例发生感染性休克前兆;术后住院2～6天;2周～1个月拔除双J管,复查B超、KUB、IVP,结石排净率97.1%(264/272),肾盂积水由(2.6±0.6)cm降至(1.4±0.4)cm(P<0.01);随访3～24个月,3例发现输尿管狭窄。结论:输尿管镜钬激光碎石治疗嵌顿输尿管结石安全、有效,尤其适用于中、下段嵌顿输尿管结石。
Objective： To evaluate the efficacy and safety of ureteroscope lithotripsy with Holmium laser for treatment of ureteral stone with granulation. Methods：From October 2005 to May 2008, a total of 268 patients （156 males and 112 females, with an average age of 50.2 years）of ureteral stones with granulation underwent ureteroscope lithotripsy using Holmium laser at our institute, the clinical data were retrospectively analysed. Results： The overall rate of successful fragmentation for all levels of ureteral stones in a single procedure achieved 92.6 （252/272）. The success rates of fragmentation for the upper and mid lower levels of ureteral stones was 84.6% （66/78）and 95.9%（186/194）, respectively. The mean operative time and fragmentive time was 35 min and 15 min; 9 upper ureteral stone patients were replaced by minimally invasive percutaneous nephrolithotomy; 8 patients received double J tube and extracorporeal shock wave lithotripsy after one week because of stone escapsed; The mean postoperative hospitalization was 1 -5 days. 4 patients were complicated with ureter perforation; Urinry tract infection（〉38.5℃）2 days）after operation was seen in 18 patients, 5 patients was over 39 ℃ ,only one pa tient with septic shock. All the patients pull out double J tube after two weeks to one month, the stone free rate was 97 % （264/272）and the hydronephrosis was markedly decreased from preoperative（2.6±0.6）cm to postopera rive（ 1.4±0.4）cm according to B ultrasound or IVU（P〈0.0l）. 3 cases occurred ureteral stenosis after follow-up from 3 to 24 months. Conclusions：Ureteroscopy and Holmium laser lithotripsy is a highly effective, minimally invasive and safe therapy for treatment of ureteral stone with granulation, especially for those with middle or lower levels of ureteral stone with granulation.
出处
《临床泌尿外科杂志》
2008年第11期846-848,共3页
Journal of Clinical Urology
