经输尿管镜钬激光碎石术治疗泌尿系结石(附280例报告)

目的 探讨泌尿系结石经输尿管镜钬激光腔内治疗的有效性及安全性。方法 回顾性分析2003年12月至2004年12月收治的经输尿管镜钬激光治疗泌尿系结石280例的临床资料。280例中肾结石66例，输尿管结石205例，膀胱结石7例，尿道结石2例。其中147例伴有患侧轻～中度肾盂积水，56例合并结石远端输尿管狭窄，79例合并有息肉形成或肉芽组织包裹，71例为ESWL治疗失败后。结果 280例中263例单次手术碎石成功，单次手术结石粉碎率达93．9％（263／280），13例结石在钬激光碎石过程中移位于肾盏，术后再行ESWL治疗；2例进镜时输尿管穿孔，2例术中退镜时输尿管粘膜撕脱改为开放手术。结论 经输尿管镜钬激光碎石术治疗泌尿系结石安全、有效，尤其适用于结石合并输尿管狭窄、结石合并息肉形成或结石嵌顿包裹以及体外冲击波碎石无效的患者。

Treatment of ureteral calculus with Holmium:YAG laser lithotripsy via ureteroscope (report of 280 cases)

Objective To study the therapeutic effect and safety of Holmium:YAG laser on the treatment of urinary complicated calculus via ureteroscope.Methods Investigated the clinical material on Holmium:YAG laser endoscopic treatment of 280 cases with urinary calculus between December 2003 to December 2004.In 280 cases,66 of them are kidney calculus,205 are ureteral calculus,7 are bladder calculus and 2 of them are ureteral calculus.Among them,147 cases have hydronephrosis,56 cases with ureteral stricture,79 cases with polypus and 71 cases fail of ESWL.Results 93.9%(263/280) stones were fragmented in one treatment session.Complications were observed in 6.1%(17/280) cases mainly of calculus shift and perforation.Conclusion Treatment of urinary calculus with this method has been safe,effective and less invasive,especially those combine ureteral stricture,polypus or failure of ESWL.