输尿管软镜钬激光碎石术治疗上尿路结石63例 - 海南医学.pdf

海南医学2013 年3 月第24 卷第6 期 Hainan Med J, Mar. 2013, Vol. 24, No. 6 doi:10.3969/j.issn.1003-6350.2013.06.0375 ·临床经验· 输尿管软镜钬激光碎石术治疗上尿路结石63 例 肖运政，周 琦，袁淦宁，何 冬，赵树华，熊 丽 （深圳市西丽人民医院泌尿外科，广东 深圳 518055） 【摘要】 目的 评价输尿管软镜结合钬激光处理上尿路结石的有效性、安全性，分析输尿管软镜碎石成功 率的影响因素。方法 本组63 例，结石直径10~20 mm，平均14 mm。结石位于上盏6 例，中盏5 例，下盏4 例， 肾盂12例，多肾盏结石6 例，输尿管上段结石30 例。应用200 μm 光纤0.8`1.5 J/10~15 Hz 功率钬激光碎石。4 周 后复查KUB 或尿路CT ，评估结石排净率。结果 总碎石成功率为98.4% (61/62) ，下盏结石碎石成功率66.7% (2/3) （1例下盏结石术中未寻及），总结石排净率为87.3% (55/63) ，输尿管上段、肾中上盏及肾盂内结石术后排净 率为91.5% (54/59) ，肾下盏结石术后结石排净率为25.0% (1/4) 。无输尿管穿孔、撕脱及大出血等严重并发症。 结论 输尿管软镜结合钬激光是处理直径20 mm 上尿路结石的安全有效的手段。肾上、中盏及肾盂内结石较 肾下盏结石碎石成功率高、结石排净率高。 【关键词】 输尿管软镜；钬激光；碎石术；尿路结石 【中图分类号】 R699.4 【文献标识码】A 【文章编号】 1003—6350（2013 ）06—0876—03 Clinical efficacy of flexible ureteroscope combined with Holmium laser in the treatment of upper urinary calculi: a report of 63 cases. XIAOYun-zheng,ZHOUQi,YUANGan-ning,HEDong,ZHAOShu-hua,XIONGLi. DepartmentofUrology,XiliPeoplesHospital,Shenzhen518055,Guangdong,CHINA 【Abstract 】 Objective To evaluate the efficacy and safety of flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi, and to analyze the influencing factors of the success rate of lithotripsy. Methods Sixty-three patients with upper urinary calculi were enrolled in the study, with the stone size ranged from 10~20 mm in diameter (14 mm in average), including 30 patients of upper ureteral calculi, 6 of upper calyx calculi, 5 of middle calyx calculi, 4 of lower calyx calculi, 12 of pelvis calculi, and 6 of multiple calyx calculi. The 220 μm Hol- mium laser lithotripsy was performed by flexible ureteroscope. The p