输尿管镜联合钬激光治疗输尿管上段结石:附205例报告

目的 探讨输尿管镜联合钬激光治疗输尿管上段结石的效果和安全性.方法 回顾性分析205例输尿管上段结石患者行输尿管硬镜钬激光碎石治疗的临床资料,其中男91例,女114例,结石位于单侧188例,双侧17例,炎性息肉引起输尿管腔明显狭窄者12例.结石长径0.8～1.4 cm.结果 192例一次性碎石成功,单次碎石成功率为93.7%(192/205).9例有较大结石碎片(4～6 mm)残留于肾或输尿管内,4例在碎石过程中结石冲入肾内,其中1例较大结石(1.4 cm)移位至肾盂后改行PCNL,其余3例留置双J管改行ESWL,均治愈.19例合并炎性息肉同期行激光烧灼.手术时间15~90min,平均30 min.住院时间2~9 d,平均3.5 d.198例患者在门诊获得随访,随访时间3～24个月,平均6个月,结石均排尽.结论 输尿管镜联合钬激光治疗输尿管上段结石的一种比较理想的腔内碎石技术,其碎石成功率高,并发症发生率低,创伤小,患者术后恢复快,而且可同期处理结石合并炎性息肉和狭窄.

Treatment of proximal ureteral calculi with ureteroscopic holmium:YAG laser lithotripsy:Report of 205 cases

Objective To assess the efficacy and safety of ureteroscopy with holmium:yttrium-aluminium-garnet(Ho:YAG) laser lithotripsy for proximal ureteral stones.Methods A series of 205 patients with proximal ureteral calculi were treated with rigid ureteroscopy combined with Ho:YAG laser lithotripsy from May 2005.Stones ranged in size from 0.8-1.4 cm.Results The initial stone-free rate in all patients achieved 93.7%(192/205) in our procedure except for thirteen residual stones.Some residual fragment(4-6 mm) were in the kidney or the ureter in nine cases of those,and four ureteral stones were migrated into the renal pelvis and calices during the procedure.One removal stone was underwent by percutaneous lithotripsy(PCNL) and the other three were treated with extracorporeal shock wave lithotripsy(ESWL).Stone fragmentation or removal calculi were accomplished.There were no major complications such as ureteral perforationin or segmentation in all procedures.No laser-related complications occured.The meaning hospital stay time was 3.5 d(3-9 d).Residual stones were evaluated at first week to third months after the procedure.Our data shows high stone-free rates(93.7%) with a low complication rate(4.5%) during 3-24 months’(mean 6 mon) follow-up.Conclusions The Ho:YAG laser is an ideal and reliable intracorporeal lithotripter and highly effective and safe treatment for proximal ureteral calculi with a high success rate and low morbidity.