摘要
目的探讨末端可弯硬性输尿管肾镜联合钬激光治疗嵌顿性输尿管上段结石的临床效果和优势。方法回顾性分析我院2015年9月至2017年12月收治的75例嵌顿性输尿管上段结石患者的临床资料。男45例，女30例；年龄（42．5±3．5）岁。术前均行B超、CT平扫检查明确输尿管上段结石嵌顿。结石直径（1．6±0．3）cm；结石CT值（1025．3±215．4）HU。75例手术均采用全麻，患者取截石位，应用末端可弯硬性输尿管肾镜联合钬激光碎石。观察碎石成功率、手术时间、术中术后并发症、术后住院时间及结石清除率。结果75例均成功碎石，手术时间（38．5±11．2）min。术后发热4例，无感染性休克、输尿管穿孔、撕脱、大出血等严重并发症发生。术后住院时间（2．7±0．4）d。术后4周行泌尿系CT平扫检查，67例一期清除结石，结石清除率为89．3％（67／75）；8例残留结石直径5～8mm，行体外冲击波碎石及物理振动排石治疗，1个月后复查CT提示结石清除。结论末端可弯硬性输尿管肾镜联合钬激光治疗嵌顿性输尿管上段结石，手术安全，疗效确切，易于操控。
Objective To study the clinical efficacy and advantages of tip-flexible semirigid ureterorenoscope combined with Holmium laser lithotripsy for the treatment of impacted upper ureteral calculi. Methods We retrospectively analyzed 75 cases of impacted upper ureteral calculi treated in our hospital between September 2015 and December 2017. There were 45 males and 30 females, aged from 35 to 65 years, mean（42.5 ± 3.5 ）years. All patients were diagnosed by B-uhrasound and CT with impacted upper ureteral calculi. The mean stone diameter was （ 1.6± 0.3） cm. The CT value of stone was （ 1 025.3 ± 215.4） HU. Tip-flexible semirigid ureterorerloscope combined with Holmium laser lithotripsy were performed in all of the cases, which were under general anesthesia with lithotomy position,to observe the successful rate of lithotripsy, operation time,intraoperative and postoperative complications, postoperative hospitalization time and stone-free rate. Results All 75 cases were successfully operated. The operation time was （38.5 ± 11.2） min. Three cases had postoperative fever. No severe perioperative complications such as septic shock,ureteral perforation or avulsion occurred. The mean hospital stay of the patients was （2.7 ±0.4） d. A follow up by non-contrast CT scan was done 4 weeks after the procedure to evaluate the result. Sixty seven cases had stone clearances at the primary operation and the stone clearance rate was 89.3% （67/75）. Eight cases undergone ESWL and physical vibration lithecbole, the CT examination showed that the stones were cleared after 1 month. Conclusions Tip-flexible semirigid ureterorenoscope combined with Holmium laser lithotripsy in the treatment of impacted upper ureteral calculi had a definite effect, safe and comfortable for doctors.
作者
张华明
Zhang Huaming;Zhang Jiawei;Sun Dongchong;Shi Shengli;Deng Tianxing(Department of Urology,The 107th Hospital of the People＇s Liberation.Army,Yantai 264000,China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第8期592-595,共4页
Chinese Journal of Urology
关键词
输尿管结石
上段
输尿管镜
钬激光
碎石术
Ureteral calculi
upper
Ureteroseope
Holmium laser
Lithotripsy
