输尿管镜钬激光碎石术治疗输尿管结石.docVIP

精品论文 参考文献 输尿管镜钬激光碎石术治疗输尿管结石 （江油市人民医院泌尿外科 四川 江油 621700） 摘要：目的：探讨输尿管镜钬激光治疗输尿管结石的有效性和安全性。方法：回顾分析输尿管镜钬激光碎石术治疗输尿管结石83例病例资料：其中男性46，女性37，输尿管上段结石21例，中、下段结石62例。结石直径0.6-1.8cm。结果：单次碎石成功率为96.6%，其中上段结石碎石成功率86.0%，中、下段结石成功率100%，平均手术时间31分钟，术后1-6周复查，一次性结石排尽率98.8%。结论：输尿管镜钬激光碎石术治疗尿路结石是一种安全、有效的方法，可作为输尿管结石特别是输尿管下段结石的首选方法。 关键词：输尿管结石； 钬激光； 输尿管镜 Abstract: Objective: To evaluate the efficacy and safety of transureteroscopic holmium laser for ureteral calculi. Methods: we retrospectively reviewed the data of 83 patients (46males and 37femals) who underwent transureteroscopic holmium laser. Among these cases,21 cases had stones in the upper, 62 cases in the middle-lower ureter. The stones were 0.6~2.4cm in diameter. Result: The overall rate of successful fragmentation for all levels of ureteral stones in a single procedure achieved 96.6 %. Success rates of fragmentation in a single procedure for the upper and mid-lower levels of ureteral stones were 86.0% and100 respectively. The average operative time was 31min. The postoperative follow-up of 1 week to 6 week revealed that the stone-free rate was 98.8%. Conclusions: Transureteroscopic holmium laser lithotripsy is a highly effective and safe therapy for patients with ureteral calculi. It should be considered as first-line therapy, especially for those with middle or lower levels of ureteral stones. Keywords: ureteral calculi ；holmium laser； ureter mirror [中图分类号] R693+.4 [文献标识码] A 文章编号： 随着泌尿系腔镜技术的发展，输尿管镜已广泛应用于临床，输尿管镜下碎石术已经成为许多泌尿系结石患者首选的治疗方法（1）。2011年5月-2014年5月，我院采用输尿管镜下钬激光碎石术治疗泌尿系结石83例，效果满意。 1. 资料与方法 1.1 临床资料 本组83例，男46例，女37例，年龄22-62岁，平均年龄44岁。病史1-2年不等。输尿管上段结石21例，中下段结石62例，双侧输尿管结石8例，9例为多发结石，所有输尿管结石，均有不同程度的肾积水，输尿管结石最大2.4times;1.8cm，最小0.8times;0.6cm，1例输尿管中下段结石形成石街约4cm长。所有患者均行KUB+IVP检查，32例患侧输尿管不显影，11例显影不清，45例ESWL碎石2-3次不等。 1.2 治疗方法 采用德国WOLF8.0/9.8输尿管镜,瑞科恩钬激光碎石机，光纤直径600um。患者均采用持续硬膜外麻醉，取截石位，用等渗盐水作冲洗液直视下输尿管镜经尿道进入到膀胱，找到患侧输尿管开口，经输尿管镜工作通道向患侧输尿管开口插入斑马导丝，在斑马导丝引导下沿轴线旋转镜体，挑起导丝进入输尿管开口，进镜后保持视野清晰，控制速度，以导丝引导进镜，并观察输