钬激光腔内治疗在小儿泌尿系统疾病的初步应用

钬激光腔内治疗在小儿泌尿系统疾病的初步应用 陈映鹤 王爱和 虞海峰 李仲荣 陈肖鸣 温州医学院附属第二医院（育英儿童医院） 泌尿外科，小儿外科 浙江，温州（325027） 目的 评价钬激光腔内治疗小儿泌尿系统疾病的方法和疗效。方法 回顾2005年3月以来采用钬激光腔内治疗18例小儿泌尿系统疾病的临床资料，男12例，女6例，年龄1.0～14岁，平均6.6岁。输尿管结石6例，上段1例、中下段5例，直径0.5～0.9cm。后尿道及膀胱结石7例，结石直径0.8～1.5cm。先天性单纯性输尿管口囊肿3例，直径2.0cm～3.5cm。前、后尿道狭窄各一例，长度为0.4cm和和0.5cm。进行输尿管镜和小儿膀胱镜下钬激光腔内微创治疗。结果 6例输尿管镜下钬激光输尿管碎石术、7例小儿膀胱镜下钬激光膀胱结石碎石术、3例输尿管镜下钬激光输尿管囊肿去顶开窗术和2例尿道狭窄内切开加疤痕组织切除术均一次成功，无并发症。手术时间8～25min，平均16min。尿道狭窄术后留置导尿管2周，住院15天；其余病人术后留置导尿管1～3天，住院2～5天。双“J”管术后2周拔除。结石术后随访2～12个月无残留和复发，原伴随的肾积水消失；输尿管口囊肿术后随访3～9个月无膀胱输尿管返流；尿道狭窄术后1个月和3个月时各预防性尿道扩张一次，随访4～12个月排尿通畅。结论 初步应用表明钬激光腔内治疗小儿泌尿系统疾病安全、有效、微创，但需要积累更多的病例和更长时间的随访。 [关键词] 泌尿系疾病；内窥镜外科手术；激光 Teatment of urologic disease in children with endoscopic Holmium : YAG laser CHEN Ying-he，WANG Ai-he，YU Hai-feng，LI Zhong-rong，CHEN Xiao-ming.Department of Urology and Pediatric Surgery.The Second Affiliated and Yuying Children’s Hospitol of Wenzhou Medical College .Wenzhou Zhejiang 325027，China. E-mail：ChenYH@Abstract] Objective To evaluate the method and clinical efficacy with endoscopic Holmium:YAG laser on the treatment of urinary disease in children.Methods We reviewed the treatment and outcome of 18 children，6 girls and 12 boys，with age ranging from 1.0 to 14 years (mean 6.6 years). One upper ureter stone and 5 mid and lower ureter stone with hydronephrosis，and the stone size ranged from 0.5 to 0. 9cm.Bladder stone in 7 cases and the stone size ranged from 0.8 to 1.5cm.Simple ureterocele in 3 cases the diameter from 2.0 cm～3.5cm. One Anterior and 1 posterior urethral stricture with length 0.4cm and 0.5 cm.All the children underwent ureteroscopic or Pediatric cystoscopic procedures with endoscopic Holmium:YAG laser.Results 6 ureteroscopic and 7 Pediatric cystoscopic Holmium:YAG laser lithotripsys，3 ureteroscopic Holmium:YAG laser incision for ureterocele and 2 procedure for urethral stricture were performed successfully without complication. Operating time ranged from 8 to 25 minutes （mean 16 minutes）.The cases of urethral st