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【摘要】 目的 探讨钬激光治疗输尿管结石的疗效。 方法 分析2002年10至2008年4月输尿管镜下钬激光治疗236例输尿管结石的临床资料。结果 220例一次碎石成功,碎石成功率93.22%;14例结石上移到肾脏,留置双J管后行体外冲击波碎石治疗(ESWL);2例改行开放手术。术中无输尿管穿孔、撕裂等并发症发生。结论 输尿管镜下钬激光治疗输尿管结石具有损伤小、痛苦少、安全、效果确切、恢复快等优点,是一种治疗输尿管结石的较好方法,如与ESWL结合应用,效果更佳。
【关键词】 钬激光;输尿管结石;体外冲击波碎石
Ureteral stones treated by ureteroscory and HO:YAG Laser lithotripsy (Report of 236 cases)
CAO Zhi-hua, LI Ming-lin, LI Peng.Department of urology, Center hospital, Nanyang 473009,China
【Abstract】 Objective To evaluate the clinical effect ofHO:YAG laser lithotripsy on the treatment of ureteral stones.Methods To analyze the clinical data of 236 cases of ureteral stone were ureteroscopicaly treated by the use of the above mentioned lithotripsy from Oct.2002 to apri.2008.Results 220 cases were fragmented after a single session, the achievement ratio was93.22%;14 cases stones transferred onto the kidney, leave double J tube befoe Extracorporeal Shock Wave Lithotripsy( ESWL);2 cases change to patefaction operation.No complication such as perforation, laceration were encountered in operation.Conclusion Treatment of ureteral stones with this method has adventages of less invasive and pain,effective, safe and recover fast.it"s a good treatment modality for ureteral stones.The results would be better if used combined with ESWL.
【Key words】 HO:YAG laser; Ureteral stones; ESWL
2002年10至2008年4月应用美国产钬激光机治疗236例输尿管结石,效果满意,现报告如下。
1 资料与方法
1.1 临床资料 本组236例,男186例,女50例,年龄17～67岁,平均47岁;右侧结石96例,左侧结石119例,双侧21例;输尿管上段结石40例,中段81例,下段115例;结石大小0.7 cm×0.5 cm～2.1 cm×1.5 cm;结石停留时间3 d～5年;38例曾行ESWL治疗,未粉碎,8例曾行同侧或对侧输尿管结石开放手术治疗。所有患者术前均行B超、IVU检查,对患侧不显影者加行逆行插管造影检查。
1.2 治疗方法 取截石位,采用硬膜外麻醉。女性患者若为输尿管下段结石可以采用尿道表面麻醉。在注水情况下,F8�9.8输尿管硬镜从尿道进入膀胱,找到输尿管开口,插入安全导丝,在导丝引导下进入输尿管镜。窥见结石后拔出导丝,插入550μm激光传导光纤,直抵结石,将结石击碎成粉末状及细颗粒状,结石必须击碎到直径1.0 J时,可能产生较大的碎石块,不利于结石粉碎[2]。� 在碎石过程中结石可能会上移到肾盂或肾盏,我们采取以下措施,以防结石移位或处理结石移位:①设定功率在
