经皮肾镜碎石联合钬激光内切开术治疗 65 例输尿管上段结石并狭窄

目的：探讨经皮肾镜碎石联合钬激光内切开成形术治疗输尿管上段结石并狭窄的方法与疗效。方法：回顾性分析2008年6月-2012年6月本院收治的65例输尿管上段结石并狭窄患者的临床资料，男36例，女29例。年龄27-68岁，平均52岁。结石直径0.6-2.1 cm，平均（1.2±0.2）cm，合并肾积水2-6 cm，平均（3.5±0.2）cm。应用经皮肾镜碎石取石联合使用钬激光内切开成形术治疗。统计分析术后并发症、结石清除率及肾积水、肾小球滤过滤变化情况，对比手术前后IVU造影及CTU检查结果情况。结果：B超定位下65例手术均成功完成，清石率98.35%，无术中、术后大出血，无发热及其他重大并发症发生。术后随访6-36个月，平均12个月。肾积水明显减少56例，肾积水无明显变化9例，行输尿管镜下内切开术术后好转。术后患者IVU或者CTU肾显影改善。术后肾小球滤过滤由（15.2±5.9）mL/min升至（25.8±9.3）mL/min。结论：经皮肾镜联合钬激光治疗输尿管上段结石并狭窄是输尿管上段结石并狭窄安全有效的方法。

Percutaneous Nephrolithotomy Combined Holmium Laser Endoincision in the Treatment of 65 Cases Upper Ureteral Stone with Stenosis

Objective：To evaluate the technique and clinical effect of PCNL combined holmium laser en doincision in the treatment of upper ureteral stone with stenosis.Method：Sixty-five patients including 36 males and 29 females who underwent PCNL combined holmium laser endoincision for upper ureteral stone with stenosis from June 2008 to June 2012 were retrospectively analyzed.The mean patient age was 52 years（range from 27 to 68 years）,the mean stone size was（1.2±0.2）cm（range from 0.6 to 2.1 cm）,the mean hydronephrosis size was（3.5±0.2）cm（range from 2 to 6 cm）.All patients were treated with PCNL combined holmium endoincision.Postoperative complications,the stone clearance rate,hydronephrosis and GFR changes,IVU and CTU situation before and after surgery were analyzed.Result：Under ultrasonic guidance all the 65 operations were completed successfully.A 98.35%stone clearance rate was achieved,no serious complications such as hemorrhage,infection and fever were observed in intraoperation and postoperation.All patients were followed up for 6 to 36 months,average 12 months.56 patients with hydronephrosis improved significantly,9 patients with no significant changes but improved following holmium laser endoureterotomy.All patients achieved significant improvement in imaging study comparing of preoperative and postoperative data.GFR was raised from（15.2±5.9）mL/min to（25.8±9.3）mL/min after surgery.