输尿管软镜联合钬激光治疗肾结石78例的疗效观察.docVIP

输尿管软镜联合钬激光治疗肾结石78例的疗效观察 鲁栋梁1崔曙 1邓显忠 1唐铁龙1 姜果 1龚志勇 1朱平宇1 【摘要】目的 探讨输尿管软镜联合钬激光治疗肾结石的疗效。方法 2012年10月~2013年3月我院采用输尿管软镜联合钬激光治疗肾结石78例，结石大小0.8~2.7cm，平均1.8cm。术中在亲水超滑导丝引导下推入输尿管软镜鞘，使用200um光纤行钬激光碎石，钬激光功率为0.8~1.0J/10~20Hz。结果 一次进境成功率为93.6%（73/78），余5例进镜失败者在留置双J管两周后成功进镜。77例软镜成功进镜后寻及结石，结石寻及率为98.7%（77/78），其中70例成功碎石，一次手术碎石成功率89.7%（70/78），2例患者因结石较大，术中渗血视野模糊致碎石不完全，采用二次输尿管软镜碎石。手术时间20-90min，平均68min，住院时间3-7d，平均5.3d，其中2例因钬激光伤及肾盏致出血，发生感染性休克1例，无输尿管穿孔、撕脱等并发症。术后4周行尿路平片检查，75例均一期排净结石，结石清除率为96.1%（75/78）。结论 输尿管软镜联合钬激光治疗肾结石具有安全、疗效确切、并发症少等优势，尤其对于无肾脏积水或积水较轻的结石患者具有良好的应用价值。 关键词 输尿管软镜 钬激光 碎石 中图分类号：R692.4 文献标识码：A Efficacy of Flexible Ureteroscopy Combined with Holmium laser Lithotrepsy for Seventy-eight Renal Stones LU Dong-liang,CUI Shu1 , DENG xian-zhong1 ,TANG Tie-long1,Jiang Guo1 ,Gong Zhi-yong1,ZHU Ping-yu1 (1Urology Department of Affiliated Hospital of North Sichuan Medical College ， Si Chuan Nan Chong 637000) [Abstract] Objective To evaluate the therapeutic effect of flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal calculi.Methods From September 2012 to March 2013 we used holmium laser and flexible ureteroscope to treat 78 cases of renal calculi.The diameter of the stones ranged from 0.8-2.7 cm with a mean of 1.8cm.We inserted the guide wire under the vision of F8/9.8 rigid ureteroscope,then F12/14 flexible ureteral access sheath.The stones were fragmentized and removed by using 200-um Ho-YAG laser (0.8-1.0J/10-20Hz).Results In 5 patients the rigid ureteroscope or the ureteral sheath couldn’t be inserted in the first time and the success rate of the ureteroscopic insertion was 93.6%（73/78）. T o the patients which the flexible ureteroscopy could not be inserted ,a F6 double-J stent was setup, 2 weeks later the re-ureteroscopy was successful .The calculi detection rate and one-session success rate was 93.6%（73/78）and 89.7%（70/78）. 2 cases undergone the second ureteroscopy because capillary hemorrhage result eyesight ambiguity.The operation time ranged from 20