钬激光治疗输尿管结石并发狭窄的处理策略

目的：探讨腔内钬激光治疗输尿管结石并发狭窄的处理策略.方法：收集36例输尿管镜下钬激光切开治疗输尿管结石并发狭窄患者的临床资料.结果：35例手术成功,1例单纯壁间段狭窄者予钬激光切开后仍无法上行,手术终止.术后共随访12～45个月,平均（23.8±9.5）个月.30例治愈或好转,有效率为83.3%（30/36）.6例无效（5例术后1～3个月结石复发,复行腔内激光手术,随访18～24个月,其中4例治疗有效,1例效果不佳.结论：经尿道钬激光碎石术（TUL）在治疗上尿路结石时可同时处理输尿管狭窄,是一种安全有效的手段.钬激光切开治疗狭窄的疗效（85.2%,23/27）要好于硬性扩张（77.8%,7/9）,但两者比较无统计学意义（P＞0.05）根据术中具体情况实施操作可能更具实用价值,不仅能够减少操作所需时间,且预后理想.我们倾向性认为中下段狭窄的预后（93.1%,27/29）较上段（57.1%,4/7）较好（P＜0.05）,但其处理方法选择标准及处理策略仍有待进一步探讨和完善.

Holmium Laser for the Management of Ureteral Calculi Concurrent with Strictures

Objective：Talk about Holmium Laser for the management of Ureteral Calculi concurrent with strictures. Methods： 36 patients of ureteral strictures concurrent with stone impaction underwent endoscopic management. Results： Endoscopic management was successful in 35 patients while ureteroscopy could still not through the lesions after laser endoureterotomy in 1 patient, no major complications resulted from the approach with a mean follow up of （23.8±9.5） months（range 12 to 45） in all cases. 30 case were cured or improved, the total effective rate rate was 83.3% （30/36）. 6 cases were invalid in which 5 cases recurred with hydronephrosis or stones and were treated with second laser management（4cases were cured and 1 case was invalid）. Conclusions：Our result sug gests laser management is a safe and effective method to deal with concurrent ureteral strictures while crash the stones. Holmium laser incision of the efficacy of narrow （85.2%, 23/27） is better than rigid expansion （77.8%, 7/9） . The cure rate between laser endoureterotomy and rigid dilatation shows no significant difference （P〉0.05） ,according to the specific circumstances surgery may be more practical implementation of operations, not only can reduce the operating time, but aslo prognosis is good ,We believe that the lower tendency of the prognosis of stenosis （93.1%, 27/29） is better than the previous paragraph （57. 1%, 4/7） （P〈0.05）. However, its treatment of the selection criteria and treatment strategies remain to be further explored and improved.