摘要
目的:探讨内置3F输尿管导管低压注水配合输尿管镜钬激光碎石术治疗输尿管结石的安全性及有效性。方法:回顾我院2011年8月~2016年8月采用内置3F输尿管导管低压注水配合输尿管镜钬激光碎石术治疗输尿管结石患者255例(共267侧)。首先将切除盲端的3F输尿管导管通过硬膜外导管连接装置连接静脉延长管自制术中注水装置备用,术中输尿管硬镜循导丝置入输尿管,到达结石位置,置入3F输尿管导管至嵌顿结石下方或活动结石上方3~5cm,助手低压注射器注水,维持术野清晰,置入550μm钬激光光纤碎石,粉碎结石后,将导管置于碎石上方,边注水边配合退镜将结石碎片冲出。结果:共245侧输尿管镜成功到达结石位置,其中25侧因整体或部分结石(>4mm)移位导致结石残留,输尿管上段、中段和下段结石上移率分别为25%(18/72)、10%(5/50)和1.6%(2/123)。术中1例输尿管穿孔,术后1例高热。结论:内置3F输尿管导管低压注水配合输尿管镜钬激光碎石术,能够维持术野清晰,降低结石上移逃逸率,提高术中清石率,减少并发症,临床效果确切。
Objective： To evaluate the efficacy and safety of built-in 3F ureteral catheter low-pressure perfusion for treating ureteral stones in transureteroscopic holmium laser lithotripsy. Method： From August 2011 to August 2016, 255 patients （267 sides） with ureteral stones underwent transureteroscopic holmium laser lithotripsy com- bined with built-in 3F ureteral catheter low-pressure perfusion. During the procedures, when ureteroscope reached the lower part of the stone follow the guide wire, firstly, a 3F ureteral catheter with waterflood installation was inserted and approached the impacted stone, or crossed by movable stone and 3-5 cm upwards. Then injected nor- mal saline through the catheter discontinuously and fragmentized stones by using 550 μm holmium laser. Finally, stone fragments were flushed out of the ureter by withdrawing the ureteroscope and the flow flushing downwards. Result： In 245 sides of successful ureteroscope insertion, 25 of them failed to be fragmentized thoroughly for the whole or the part （）4 ram） of the stone moving upwards. The rate of stone moving upwards for the upper, mid- dle and lower ureteral stones were 25% （18/72）, 10%（5/50） and 1.6% （2/123）, respectively. After operation, there was one patient with urinary tract infection who suffered from fever over 39℃. There was one side with ureteral perforation. Conclusion： Built-in 3F ureteral catheter low-pressure perfusion in transureteroseopic holmium laser lithotripsy can be performed under clear vision, effectively prevent the stones moving upwards and easily flush out the stone fragments. It is a safe procedure with high efficacy and fewer complications.
作者
张英晨
程玉峰
丁吉阳
任辉杰
吴志强
赵帅
孙浩
毕文浩
成小建
蒋立城
ZHANG Yingchen;CHENG Yufeng;DING Jiyang;REN Huijie;WU Zhiqiang;ZHAO Shuai;SUN Hao;BI Wenhao;CHENG Xiaojian;JIANG Licheng.(Department of Urology, NO. 148 Hospital of PLA, Zibo, Shandong, 255300, China)
出处
《临床泌尿外科杂志》
2018年第3期229-231,234,共4页
Journal of Clinical Urology
关键词
输尿管结石
输尿管镜
钬激光
输尿管导管
ureteral stones
ureteroscope
holmium laser
ureteral catheter
