Treatment of ureteral calculi with modified ureteroscopic holmium laser lithotripsy (Report of 76 cases)
-
摘要: 目的：探讨改良输尿管镜钬激光碎石术治疗输尿管结石的手术技巧及临床疗效。方法：回顾性分析我院于2011年9月~2012年10月行改良输尿管镜钬激光碎石术治疗输尿管结石的76例患者的临床资料，观察采用F3输尿管导管引导碎石并冲洗术野，术前配合速尿静推，运用结石封堵器等手术技巧的临床疗效。结果：本组76例患者一次性碎石成功率94.7%（72/76）；上段结石碎石成功率91.3%（21/23），中下段结石碎石成功率95.6%（43/45），膀胱壁内段结石碎石成功率100%（8/8）；手术时间21~83 min，平均33 min，术后住院时间2~9 d，平均3.9 d。结论：改良输尿管镜钬激光碎石术是治疗输尿管结石安全、有效的手术方法，熟练掌握进镜技巧并采用F3输尿管导管引导冲洗术区，术前速尿的使用以及结石封堵器等应用，可以有效的提高碎石成功率，缩短手术时间及术后住院时间，并减少术中术后并发症。Abstract: Objective: To discuss the technique of modified ureteroscopic holmium laser lithotripsy in the treatment of ureteral calculi.Method: Retrospective analysis was adopted, 76 cases of ureteral caculi who underwent modified holmium laser lithotripsy with ureteroscopic from September 2011 to October 2012. Normal saline was injected slowly through F3 ureteral catheter during lithotripsy procedure. Lasix was intravenous injected preoperatively. Several cases were treated with intercept stone network. Clinical effects with such techniques of operation were observed.Result: The overall successful rate of fragmentation for all ureteral stones in a single procedure achieved 94.7%(72/76). The successful rate of fragmentation for upper ureteral stones was 91.3%(21/23). The successful rate of fragmentation for middle-lower ureteral stones was 95.6%(43/45). The successful rate of fragmentation for ureterovesical junction calculi was 100%(8/8). Total operation time was 21-83 (mean 33) min, and duration of hospitalization after operation was 2-9 d, with an average 3.9 d.Conclusion: The modified ureteroscopic holmium laser lithotripsy is an effective and safe therapy for patients with ureteral calculi. Correct and skillful ureteroscopic holmium laser management with F3 ureteral catheter guarding, the injecting of lasix and the using of intercept stone network can increase the the successful rate of fragmentation while decrease the operation time, postoperative duration of hospitalization and the complication.
-
Key words:
- ureteroscope /
- Holmium:YAG laser /
- ureteral calculi /
- ureteral catheter
-
-
[1] Elashry O M, Elgamasy A K, Sabaa M A, et al. Ureteroscopic management of lower ureteric calculi:a 15-year single-centre experience[J]. BJU Int, 2008, 102:1010-1017.
[2] Zehri A A, Ather M H, Siddiqui K M, et al. A randomized clinical trial of lidocaine jelly for prevention of inadvertent retrograde stone migration during pneumatic lithotripsy of ureteral stone[J]. J Urol, 2008, 180:966-968.
[3] Bagley D, Erhard M. Use of the holmium laser in the upper urinary tract[J]. Tech Urol, 1995, 1:25-30.
[4] Wollin T A, Razvi H A, Denstedt J D. Identifying stone composition using infrared analysis of filtered urine after ureteroscopic lithotripsy[J]. J Endourol, 1999, 13:499-503.
[5] Lam J S, Greene T D, Gupta M. Treatment of proximal ureteral calculi:holmium:YAG laser ureterolithotripsy versus extracorporeal shock wave lithotripsy[J]. J Urol, 2002, 167:1972-1976.
[6] 袁润强, 魏佳莉, 李志坚, 等. 钬激光、ESWL、气压弹道碎石术治疗输尿管结石的疗效比较[J]. 临床泌尿外科杂志, 2001, 16(11):456-457.
[7] 黄云腾, 盛旭俊, 孔良, 等. 输尿管镜下钬激光碎石术治疗输尿管上段嵌顿结石的疗效分析[J]. 第二军医大学学报, 2006, 27(7):805-806.
[8] 陈修德, 张安学, 于江, 等. 经尿道输尿管镜扩张术治疗输尿管下段狭窄118例临床分析[J]. 泌尿外科杂志(电子版), 2010, 2(3):24-26.
[9] 方友强, 邱剑光, 吴杰英, 等. 输尿管镜与后腹腔镜手术治疗输尿管上段结石的疗效比较[J]. 中华腔镜泌尿外科杂志(电子版), 2012, 6(2):24-27.
[10] 俞彬, 王伟高, 王荣江, 等. 输尿管镜钬激光治疗输尿管结石合并息肉24例疗效报告[J]. 浙江中医药大学学报, 2012, 36(4):394-396.
[11] 张兵, 甄佳学, 张俊岩, 等. 输尿管镜下钬激光治疗输尿管结石并息肉51例分析[J]. 中国煤炭工业医学杂志, 2008, 11(10):1545-1546.
-
计量
- 文章访问数: 70
- PDF下载数: 129
- 施引文献: 0
下载: