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目的:分析和总结168例输尿管镜下钬激光碎石术的手术方法,评价其临床疗效。方法:回顾分析168例应用输尿管镜下钬激光碎石治疗的输尿管结石患者资料,输尿管上段结石20例、中段45例、下段103例,结石直径0.6～2.2cm,29例患者曾行体外冲击波碎石,结石并发输尿管息肉31例。手术采用硬膜外或全身麻醉,导丝引导下插入输尿管镜,行钬激光碎石,术后留置双J管2-4周。结果:手术时间18～55min,平均25min,其中输尿管上段结石一次碎石成功率85.0%,中、下段结石一次性碎石成功率98.4%。合并输尿管肉芽或息肉者均一次碎石成功。术中并发输尿管穿孔3例,术中无中转开放手术者,术后泌尿系统感染5例,术后平均住院时间3天。随访1～6个月,无结石残留及输尿管狭窄。结论:输尿管镜下钬激光碎石是一种治疗输尿管结石安全有效手术方法。
OBJECTIVE: To analyze and summarize the operative methods of 168 cases of ureteroscopic holmium laser lithotripsy and evaluate its clinical efficacy. Methods: A retrospective analysis of 168 cases of ureteral stones treated with ureteroscopic holmium laser lithotripsy, 20 cases of upper ureteral calculi, 45 cases of the middle, lower 103 cases, the diameter of stones 0.6 ~ 2.2cm, 29 patients had extracorporeal shock wave Stone, stones and ureteral polyps in 31 cases. Surgical use of epidural or general anesthesia, guided wire guide into the ureteroscope, line holmium laser lithotripsy, double J tube after indwelling for 2-4 weeks. Results: The operation time was 18-55 minutes with an average of 25 minutes. The successful rate of primary ureteral stones was 85.0%. The successful rate of primary and middle ureteral stones was 98.4%. Combined ureteral granulation or polyp were one time gravel success. Intraoperative ureteral perforation in 3 cases, intraoperative transfer without open surgery, postoperative urinary tract infection in 5 cases, the average postoperative hospital stay for 3 days. Follow-up 1 ~ 6 months, no residual stones and ureteral stricture. Conclusion: Ureteroscopic holmium laser lithotripsy is a safe and effective surgical treatment of ureteral calculi.