经尿道输尿管镜钬激光碎石治疗输尿管上段结石136例 - 海南医学.pdf

doi:10.3969/j.issn.1003-6350.2013.06.0376 ·临床经验· 经尿道输尿管镜钬激光碎石治疗输尿管上段结石136 例 雷 鸣，袁 坚，刘永达，罗金泰，张 泽，何朝辉 (广州医学院第一附属医院微创外科中心泌尿外科，广东省泌尿外科重点实验室 广东 广州 510230) 【摘要】 目的 总结经尿道输尿管镜钬激光碎石治疗输尿管上段结石的临床经验，提高治疗水平。 方法 回顾性收集136 例输尿管上段结石患者接受经尿道输尿管镜钬激光碎石的相关资料，总结手术时 间、治疗效果和主要并发症。结果 手术时间8 ～45 min ，平均22 min 。术中出现激光烧灼损伤输尿管壁者4 例(2.9%) ，无输尿管穿孔病例。术后复查碎石成功率为93.6% (131/140)。因部分或整个结石返流回肾内，需要 ESWL 辅助治疗者占6.4% (9/140)。患者术后住院平均2 d ，无严重并发症。结论 经尿道输尿管钬激光碎石治 疗输尿管上段结石碎石效率高、安全性好，值得临床推广应用。 【关键词】 输尿管结石；输尿管镜；激光；治疗 【中图分类号】R693.4 【文献标识码】A 【文章编号】 1003—6350（2013 ）06—0879—03 Clinical analysis of transurethral ureteroscopic lithotripsy combined with Holmium laser in the treatment of upper ureteral calculi: a report of 136 cases. LEIMing,YUANJian,LIUYong-da,LUOJin-tai,ZHANGZe,HE Zhao-hui.DepartmentofUrology,MinimallyInvasiveSurgeryCenter,theFirstAffiliatedHospitalofGuangzhouMedical College,GuangdongKeyLaboratoryofUrology，Guangzhou510230,Guangdong,CHINA 【Abstract 】 Objective To summarize the experiences of treating upper ureteral calculi by transurethral ure- teroscopic lithotripsy combined with Holmium laser. Methods The clinical data of 136 patients with upper ureteral calculi treated by transurethral ureteroscopic lithotripsy combined with Holmium laser were collected and analyzed. The operation time, therapeutic efficacy and the main complications were summarized. Results The operation time was ranged from 8 minutes to 45 minutes, 22 minutes in average. The wall of ureter was injured by laser in 4 patients (2.9%, 4/136), and no case of perforation of wall was found. The rate of successful lithotripsy was 93.6% (131/140). The auxiliary ESWL was needed in 9 patients (6.4%, 9/140) due to the reflux of the whole stone or frag-