钬激光碎石术治疗输尿管结石126例.docVIP

钬激光碎石术治疗输尿管结石126例 【摘要】 　　目的：探讨钬激光结合输尿管镜技术治疗输尿管结石的临床效果及并发症。方法：采用合肥科瑞达公司生产的HLM-1-30A钬激光治疗机及Wolf F8-9.8硬质输尿管镜对2005年3月至2006年10月126例输尿管结石患者进行碎石治疗。结果：一次碎石成功率达93.7%(118/126)；其中上段结石85%(41/48),中段100%,下段97.7%(46/47)；8例未成功，其中6例上段结石上移至肾脏，1例上段输尿管扭曲，1例输尿管口粘连置镜失败。结石上移主要发生于使用输尿管镜早期。术后d1 KUB检查无结石率达77.8%(98/126)其它均于2周内排净。并发症主要有输尿管穿孔2.4%(3/126),血尿100%,腰痛25.4%(32/126),结石上移4.8%(6/126),泌尿系感染6.3%(8/126)。结论：钬激光能安全,有效,快速治疗输尿管结石。使用钬激光技术进行碎石治疗时要求有较好的输尿管镜技术基础。 【关键词】 输尿管结石 钬激光 输尿管镜 　　Clinical Application of Holmium Laser in Ureteral Calculus 　　Abstract： Objective：To investigate the clinical effect and complication of Holmium laser in ureteral calculus. Method：Holmium laser（HLM-1-30A）lithotripsy were adapted to 126 cases of ureterral calculus between March 2005 to October 2006. Result:118 of 126 cases ureter stones completed stone fragmentation.Among them ,upper ureteral calculi(85%),middle ureteral calculi(100%),lower ureteral calculi(97.9%). 8 cases were abandoned, because of the stone migrations to the renal pelvis in early phase(6cases) and ureter twisting (1cases) and UO adherence (1 cases).In the 126 cases the stones were cleared off on the first postoperative day under KUB，the left stones were done among two weeks.The complication includes ureteral perforation (2.4%，3/126)haematuria (100%)，lumbago (25.4%).Stone migration (4.8%) and urinary tract infection (6.3%).Conclusion: The application of Holmium laser in lithotripter is a safe and effective procedure.The indisposition caused by procedure of cystoscope，not by Holmium laser.The Holmium laser did not increase the risk.To use Holmium laser better and ureteroscope skill better. 　　Key words： Ureteral calculus； Holmium laser； Ureteroscope 　　2005年3月至2006年10月我们应用输尿管镜钬激光碎石术治疗126例输尿管结石患者，取得满意疗效，现报告如下： 　　1 资料与方法 　　1.1 临床资料：本组126例 男72例，女 54例，年龄17～68岁，平均45岁，输尿管上段48例，其中5例并发肾结石；输尿管中.下段78例。结石最大为2.1cm×1.2cm，最小为0.6cm×0.5cm。手术时间15～78min，平均26min，激光功率12～18周，平均术后住院时间为2.5d，有51例患者有一次至多次ESWL未成功的病史；35例合并有炎性息肉；72例合