组合式输尿管软镜联合钬激光治疗上尿路结石48例报告

目的 评价组合式输尿管软镜联合钬激光在上尿路结石治疗中的临床应用价值。方法 应用德国铂立组合式输尿管软镜联合钬激光治疗上尿路结石48例，33例患者术前留置双J管1周以上。结石最大直径1.0～2.5cm，经输尿管软镜推送鞘或沿导丝直接置入F8输尿管软镜，寻及结石后，200μm光纤行钬激光碎石，碎石功率1.0～1.5J/10～20Hz，8周后复查评估结石排净率。结果 一次进镜成功率100％，结石寻及率93.7％(45/48)，单次碎石成功率95.5％(43/45)。总结石排净率为73.3％(33/45)，手术时间30～180min，术后平均住院4d，无严重并发症。结论 组合式输尿管软镜联合钬激光治疗上尿路结石微创、安全，疗效确切，并发症少，特别适用于体积较小且单发的结石患者。

Treatment of modular flexible ureteroscopy combined with Holmium laser lithotripsy for upper urinary calculi: report of 48 cases

Objective To evaluate the clinical effect of modular flexible ureteroscopy combined with Holmium laser lithotripsy for upper urinary calculi. Methods 48 cases of upper urinary calculi were treated with Holmium laser lithotripsy through a modular design and semi-disposable flexible ureteroscope. The pig-tai1 stent would be set into ureters of 33 case more than 1 week before the operation. The diameter of the stones ranged from 1.0 to 2.5cm.Flexible ureteroscope was used during the procedure with or without the placement of a ureteral access sheath. The stones were fragmentized and removed by 200μm Holmium laser(1.0～1.5J/10～20Hz). The follow-up was carried on 8 weeks after the procedure to evaluate the result of the endoscopic lithotripsy. Results The successful rate of the ureteroscopic insertion was 100％.The successful rate of stone search was 93.7％(45/48).The successful rate of stone fragmentation after the single session was 95.5％(43/45). The total evacuation rate of the calculi was 73.3％(33/45).Operation time ranged from 30 to 180min. Average of hospital stay after the operation was 4 days. No severe complications occurred. Conclusion Holmium laser lithotripsy through modular flexible ureteroscope is a safe and effective treatment modality for upper urinary calculi, especially for those with minor diameter.