输尿管软镜联合钬激光治疗肾结石78例的疗效观察

目的:探讨输尿管软镜联合钬激光治疗肾结石的疗效。方法:2012年10月至2013年3月我院采用输尿管软镜联合钬激光治疗肾结石78例,结石大小0.8².7 cm,平均1.8 cm。术中在亲水超滑导丝引导下推入输尿管软镜鞘,使用200μm光纤行钬激光碎石,钬激光功率为0.82.7 cm,平均1.8 cm。术中在亲水超滑导丝引导下推入输尿管软镜鞘,使用200μm光纤行钬激光碎石,钬激光功率为0.8¹.0 J/(101.0 J/(10²0)Hz。结果:一次进镜成功率为93.6%(73/78),余5例进镜失败者在留置双J管两周后成功进镜。77例软镜成功进镜后寻及结石,结石寻及率为98.7%(77/78)。其中70例成功碎石,一次手术碎石成功率89.7%(70/78),2例患者因结石较大,术中渗血视野模糊致碎石不完全,采用二次输尿管软镜碎石。手术时间2020)Hz。结果:一次进镜成功率为93.6%(73/78),余5例进镜失败者在留置双J管两周后成功进镜。77例软镜成功进镜后寻及结石,结石寻及率为98.7%(77/78)。其中70例成功碎石,一次手术碎石成功率89.7%(70/78),2例患者因结石较大,术中渗血视野模糊致碎石不完全,采用二次输尿管软镜碎石。手术时间20⁹0 min,平均68 min,住院时间390 min,平均68 min,住院时间3⁷ d,平均5.3 d,其中2例因钬激光伤及肾盏致出血,发生感染性休克1例,无输尿管穿孔、撕脱等并发症。术后4周行尿路平片检查,75例均一期排净结石,结石清除率为96.1%(75/78)。结论:输尿管软镜联合钬激光治疗肾结石具有安全、疗效确切、并发症少等优势,尤其对于无肾脏积水或积水较轻的结石患者具有良好的应用价值。

Efficacy of flexible ureteroscopy combing with holmium laser lithotrepsy for seventy-eight renal stones

Objective：To evaluate the therapeutic effect of flexible ureteroscopy combined with holmium laser lithotripsy for the treat-ment of renal calculi. Methods：From September 2012 to March 2013,holmium laser and flexible ureteroscope were used to treat 78 ca-ses of renal calculi. The diameter of the stones ranged from 0. 8-2. 7 cm with a mean of 1. 8cm. The guide wire was inserted under the vision of F8/9. 8 rigid ureteroscope,then F12/14 flexible ureteral access sheath. The stones were fragmentized and removed by using 200 μm Ho-YAG laser （0. 8-1. 0J/10-20Hz）. Results：In 5 patients the rigid ureteroscope or the ureteral sheath couldn’t be insert-ed in the first time and the success rate of the ureteroscopic insertion was 93. 6%（73/78）. To the patients which the flexible ureteros-copy could not be inserted,a F6 double-J stent was setup,and 2 weeks later the re-ureteroscopy was successful . The calculi detection rate and one-session success rate were 93. 6%（73/78）and 89. 7%（70/78）. 2 cases undergone the second ureteroscopy because capil-lary hemorrhage result in eyesight ambiguity. The operation time ranged from 20 to 90 minutes with a mean of 58 minutes. Then mean hospital stay of the patients was 5. 3 days （3-7）. After the operation 1 patient developed septic shock and 2 patients suffered from hol-mium laser-caused calyceal hemorrhage. No patients had ureteric perforation or ureteric laceration. A follow up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the result. Seventy five cases had stone clearance at the primary operation,and the stone clearance rate was 96. 1%（75/78）. Conclusion：Flexible ureteroscopy combing with holmium laser lithotripsy is a safe,effec-tive and less complication procedure for renal calculi,especially for patients with non-nephrohydrosis or lightly nephrohydrosis.