基层医院输尿管镜钬激光碎石术治疗输尿管结石的综合疗效分析

目的探讨基层医院输尿管镜钬激光碎石术治疗输尿管结石的综合疗效、影响因素及安全性。方法回顾性分析2010年6月至2013年12月间采用输尿管镜钬激光碎石术治疗输尿管结石104例的临床资料，其中输尿管上段结石22例，中、下段结石82例。结果97例一期碎石成功，总体碎石清石成功率为93．2％（97／104），其中上段结石的一期清石率为86．3％（19／22），中、下段结石为97．6％（80／82）。手术时间为12～105min，平均（44．5±21，7）min，术后平均3～7d，平均（4．5±1。5）d。3例结石术中返回肾盂，术后改体外冲击波碎石治疗；4例因输尿管严重扭曲置镜失败，改开放手术；4例输尿管穿孔，置双J管1个月后痊愈，无输尿管撕脱、断裂等严重并发症，12例术后出现泌尿系感染。术后随访1～12个月，平均4个月，1个月内结石排净率为100％。结论在基层医院开展输尿管镜钬激光碎石术治疗输尿管结石安全、疗效可靠。

Analysis of comprehensive effect of primary hospital ureteroscopic holmium laser lithotdpsy for ureteral stones

Objective To evaluate the efficacy and safety of holmium： YAG laser lithotripsy for the treatment of ureteral calculi in primary hospitals. Methods The clinical materials of 104 patients with ureteral stones in our hospital underwent ureteroscopic by holmium： YAG laser lithotripsy from June 2010 to December 2013 were analyzed. Among these patients, 22 patients with stones were in the upper ureter, and 82 cases were in the mid-lower level. Results 97 cases were lithotripsied successfully in stage I. And the overall successful rate was 93.2%（97/104）, while the stone-free upper ureteral and mid-lower ureteral were 86.3%（19/22） and 97.6%（80/82）, respectively. The average operation time was（44.5±21.7,12-105 min）. The average postoperative hospitalization was （4.5±1.5, 3-7 d）. Calculi rushed back to the pelvis in 3 cases, then turned to ESWL. Ureter distorted seriously in 4 cases and failed and changed to open operation. Ureteral perforation in 4 cases and recovered after indwelling double J tube for one months without serious complications of ureteral laceration. 12 cases were found urinary infection. 97 cases were followed up for （4, 1-12 months）. All stones were free after 1 months. Conclusion Ureteroscopic holmium： YAG laser lithotripsy is a safe and reliable method for ureteral calculi.