摘要
目的探讨输尿管软镜钬激光碎石术治疗上尿路结石的疗效。方法 2012年10月~2015年11月采用输尿管软镜钬激光碎石术治疗86例上尿路结石,其中肾结石60例,输尿管上段结石26例,结石直径0.8~2 cm。术中输尿管硬镜探查患侧输尿管,留置导丝并引导置入F_(12/14)输尿管软镜外鞘,输尿管软镜通过外鞘进入输尿管上段及肾盂,寻找肾脏各盏结石及输尿管上段结石,连接200μm钬激光高频率低能进行碎石,使结石粉末化(结石<2 mm),稍大的结石碎片通过镍钛合金套石网篮取出,术毕留置导丝并撤出输尿管软镜,沿导丝留置双J管。若输尿管软镜不能通过导丝直接插入,留置F_6双J管2周后再行输尿管软镜碎石。术后4周复查CT评估碎石效果。结果 86例手术均获成功,手术时间30~90 min,(50.5±10.6)min。结石清除率93.0%(80/86),其中肾盂及上盏清石率100.0%(25/25),中盏清石率94.4%(17/18),下盏清石率77.8%(7/9),多个肾盏清除率87.5%(7/8),输尿管上段结石清石率92.3%(24/26)。术后住院时间1~5 d,(2.6±0.5)d,术后2周复查KUB及CT平扫,结石清除率96.5%(83/86)。无尿脓毒血症、出血、穿孔及尿外渗等并发症。结论输尿管软镜钬激光碎石术治疗上尿路结石安全可靠,是值得推广的腔内手术方式。
Objective To investigate the curative effect of flexible ureteroscopie holmium laser lithotripsy for upper urinary tract calculi. Methods Between October 2012 and November 2015, a total of 86 patients with upper urinary tract calculi received flexible ureteroseopic holmium laser lithotripsy （60 cases of kidney stones and 26 cases of upper ureteral calculi）. The stone size was 0.8 - 2 cm. Under rigid ureteroscopic exploration, an indwelling guide wire was placed to introduce the F12/l4 sheath of the flexible ureteroscopy. Then the flexible ureteroscope entered the upper ureter and renal pelvis through the sheath to identify stones in the renal calyce and upper ureter. By using the 200 μm holmium laser, the stones were fragmented （ 〈 2 mm）. The larger fragments were removed with the Ni-Ti alloy basket. After the operation, the guide wire was indwelled and the flexible ureteroscope was withdrawn, and a double J ureteral catheter was placed along the guide wire. If the flexible ureteroscope could not be placed along the guide wire, a F6 double J ureteral catheter was indwelled for 2 weeks until flexible ureteroscopic lithotripsy. The effects were evaluated 4 weeks later with CT re-examinations. Results The operations were successful in all the 86 cases. The operation time was 30 - 90 min （mean, 50.5 ±10.6 min）. The overall stone clearance rate was 93.0% （80/86）, with a renal pelvis and upper ealices stone clearance rate of 100.0% （25/25） , a middle calices stone clearance rate of 94.4% （17/18） , a lower calices stone clearance rate of 77.8% （7/9） , a multiple calices stone clearance rate of 87.5% （7/8） , and an upper segment ureter stone clearance rate of 92.3% （24/26）. The hospitalization time was 1 - 5 d （ mean, 2.6 ± 0.5 d）. At 2 weeks after surgery, the KUB and CT re-examinations showed that the average stone clearance rate was 96.5% （83/86）. There was no other complication such as urosepsis, bleeding or urinary extravasation. Conclusion Flexible ureteroseopie holmium laser lithotripsy for upper urinary calculi is safe and reliable, being worthy of application.
出处
《中国微创外科杂志》
CSCD
北大核心
2017年第6期565-567,共3页
Chinese Journal of Minimally Invasive Surgery
关键词
输尿管软镜
钬激光
输尿管软镜碎石术
肾结石
输尿管结石
Flexible ureteroseopy
Holmium laser
Flexible ureteroscopie lithotripsy
Renal stones
Ureteral calculus
