输尿管石街的治疗体会.doc

输尿管镜钬激光碎石治疗输尿管石街18例分析 叶琪辉 谢磊 汤珺 虞晓勇 沈军 夏宏辉 深圳市第六人民医院（广东医学院附属南山医院）泌尿外科，广东 深圳 518052 [摘要]目的：总结输尿管镜钬激光碎石治疗输尿管石街的临床经验。方法：回顾性分析2008年6月至2010年7月期间我院采用输尿管镜钬激光技术治疗的18例输尿管石街患者的临床资料。结果：11例手术患者一次取尽结石，4例行二次手术取尽结石，3例有结石上移进入肾盂，术后行ESWL治疗排出，一例出现输尿管穿孔。结论：输尿管镜下应用钬激光技术治疗输尿管石街安全可靠、效果佳，值得推广应用。 [关键词] 　输尿管镜；钬激光；输尿管石街；双J管 18 example analyses on the management of ureteral steinstrasse with ureteroscope Ho:YAG lasers lithotripsy Yeqihui Xielei Tangjun Xiahonghui Shenjun Yuxiaoyong Sixth Peoples Hospital of Shenzhen (Nanshan Hospital of Guangdong Medical College) Department of Urology, Shenzhen, Guangdong 518052 [Abstract] OBJECTIVES: To sum up our experience in the treatment of ureteral steinstrasse with ureteroscope Ho:YAG lasers lithotripsy. METHODS: Clinical data of 18 cases of ureteroscopic Ho: YAG laser lithotripsy for Ureteral steinstrasse were collected from June 2008 to July 2010 in our department. RESULTS: 11 cases were redernded stone free in one procedure,4 cases who received repeated operation , 3 cases who The stone had moved into the renal pelvis needed to another ESWL, and one case who happened ureter perforation. CONCLUSIONS: the management of ureteral steinstrasse with ureteroscope Ho:YAG lasers lithotripsy is Safe reliable, the effect is good, is worth promoting the application . [key words] Ureteroscope；Ho:YAG lasers；Ureteral steinstrasse；Double-J tube 不能通过保守治疗的上尿路结石临床常选择体外冲击波碎石术（ESWL），但是临床上经常遇到结石长径大于1.5 cm 的输尿管结石、大于2.5 cm 的肾或者肾盂输尿管连接处的铸型结石，经ESWL 后容易形成石街,继发形成息肉包裹、严重输尿管水肿、严重梗阻感染，最终导致肾功能严重受。回顾分析我院2008 年6 月～2010 年7 月采用输尿管镜钬激光碎石治疗输尿管石街18例，效果满意，现报道总结如下： 材料与方法 一、临床资料 本组18例，其中男11例，女7例，年龄在20-59岁，平均35.5岁。输尿管中下段石街11例，输尿管中上段石街5例，上中下段都有2例。输尿管石街最长14cm，最短3.1cm,平均5.3cm。所有患者均为ESWL术后形成输尿管石街，术前全部患者均经B超、腹部平片+ 静脉肾盂造影术或磁共振水成像确诊。 二、手术方法 　采用蛛网膜下腔阻滞麻醉、持续硬膜外腔阻滞麻醉,患者取膀胱截石位,患侧下肢略低。应用德国Storz F8/ 9.5 硬性输尿管镜,国产输尿管液压灌注泵及钬激光机,钬激光能量设置:1.5～2.5 J / 8Hz ,光纤直径550μm。输尿管镜直视进镜至膀胱,找到患侧输尿管开口,先逆行置入一根斑马导丝,利用灌注泵的水压扩开输尿管壁段,并根据输尿管开口的形态,而采取“压、旋、挑、抖”的方法直视下入镜至输尿管。调小灌注速度或者停止灌注,沿输尿管导管进镜至病变部位。裸光纤激