腔内钬激光术治疗输尿管结石346例回顾性分析

目的]回顾性分析346例腔内钬激光碎石术治疗输尿管结石的疗效和失败影响因素。方法]对在本院行钬激光输尿管碎石术的346例患者，统计术中手术时间、单次手术结石粉碎率、术中并发症（输尿管损伤、输尿管穿孔）；术后住院时间、不良反应的发生率。分析钬激光术治疗输尿管结石失败的影响因素。结果]手术时间（62．3±21．2）min；单次手术结石粉碎率94．8％（328／346），术后平均住院时间（6．3±4．1）d；术后4～6周复查，结果显示输尿管中上段、下段结石的排净率比较差异有统计学意义（P〈0．01）；失败组的结石直径明显大于成功组（P〈0．05）。所有患者均有肉眼血尿，3～4d可消失，术后无感染、发热、梗阻性肾脓肿发生。碎石成功组和失败组之间年龄、性别、病程、结石数日、结石单双侧、结石区息肉情况等因素的差异无统计学意义（P〉0．05）；多因素回归分析表明，结石的位置与碎石的失败率呈显著相关（P〈0．05）；单因素回归分析结果表明输尿管狭窄、输尿管扭曲、结石的大小与碎石的失败率呈显著相关（P〈0．05）。结论]钬激光碎石术是一种高效、安全的泌尿系结石治疗手段，结石位置、合并输尿管狭窄和扭曲是影响手术结果的重要因素。

Retrospective Analysis of Uo:YAG Laser Lithotripsy in Management of 346 Cases of Ureteral Calculi

Objective]To evaluate the clinical effect of Ho ： YAG laser lithotripsy in management of ureteral calculi and to investigate its influential factors. Methods]The clinical data of 346 patients of ureteral calculi treated via ureteroscope with Ho ： YAG laser litbotripsy were analyzed retrospectively. The clinical effect and the influential factors were investigated. Results]The operation time was （62.3±21.2）min. The overall stone-free rate was 94.8% （328/346）, and the average stay was （6.3±4.1）d, and the stone-free rate of proximal stones was 87.2%（96/110）which was lower than that of distal stones（98.5%, 263/267） （ P 〈0.01）. The diameter of stone of failure group was bigger than that of success group （ P 〈0.05）. The complication was only 3-4d gross hematuria. The age, gender, course of disease, sum of stones, sides of stone and polypus of stone area bad no any effect on overall stone-free rate（ P 〈0.05）. Stone location, impaction and uretoric retortion had significant effect on stone free rate in a multivariate analysis（ P〈0.05）. Conclusion] Ho： YAG laser lithotripsy is an effective and safe treatment modality for ureteral calculi. Stone location and concomitant ureteral stricture in operation are the important influential factors of Ho：YAG laser lithotripsy.