输尿管镜钬激光治疗输尿管下段结石的效果观察.doc

输尿管镜钬激光治疗输尿管下段结石的效果观察 　　作者：姜旭,张韬,沈军　　作者单位：解放军第五医院，宁夏 银川 　　【摘要】 目的 探讨输尿管镜钬激光碎石在输尿管下段结石治疗中的应用方法。方法 取截石位，在F3输尿管导管的引导下进镜，同时引入激光光纤行碎石治疗，结石粉碎后，留置双J管，双腔导尿管接无菌尿袋留置1-3d。 结果 URS+钬激光的162例中，一次粉碎成功的151例(93.2%)，平均手术时间9-45min，术后平均住院时间4d。 3-4周拔管前结石排净率160例(98.77%)。162例中无1例输尿管穿孔、输尿管黏膜撕脱。结论 双侧急性尿路梗阻应首选URS+钬激光治疗。 　　【关键词】 输尿管下段结石;URS+钬激光 　　The application of holmium laser lithotripsy with ureteroscope in the treatment of ureteral stones in the lower segment of ureter JIANG Xu, ZHANG Tao, SHEN Jun. 　(The 5th Hospital of PLA, Yinchuan 750004, China) 　　[Abstract] Objective To discuss the method of the application of holmium laser lithotripsy with ureteroscope in the treatment of ureteral stones in the lower segment of ureter. Methods Lithotomy position was chosen and inserted the ureteroscope guided by a F3 ureter catheter at the same time introduced laser fiber to carry out the operation. Indwell a double-J catheter and Dual-chamber catheter connected with a sterile urinary bag for 1-3 days after the operation. Results 162 cases with URS+ holmium laser lithotripsy and 151 (93.2%) cases removed the stone fragments totally at the first day. The average operation time was 9 minutes-45 minutes and the average stay in hospital was 4 days. 160 cases removed all stones in 3-4 weeks before extubation accounting for 98.77%. There was no any ureteral perforation and ureteral mucosal avulsion in the 162 cases. Conclusion It is the most sensible option for patients with acute urinary tract obstruction at both sides to choose URS + holmium laser lithotripsy first. Skifully insert the ureteroscope by rotating and control the flux of the liquid with f3 catheter is the key link for successful URS+ holmium laser lithotripsy. When the stones move to renal pelvis or renal calyces ESWL can be used as a supplementary treatment. 　　[Key words] Stones in the lower segment of ureter; URS+holmium laser 　　由于输尿管镜和钬激光技术的发展，泌尿系结石的治疗已经进入了微创时代，尤其在输尿管下段结石的处理上有着明显的优势。我院从2006年9月-2008年1月应用输尿管镜技术(URS