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目的随着腔镜技术在上尿路结石治疗中的广泛应用,术中与术后大出血、严重感染、休克甚至死亡的病例也时有发生。为寻求和积累腔镜下钬激光治疗上尿路结石的经验,进一步提高治愈率。方法回顾自开展钬激光碎石以来发生4例严重并发症病例的诊治过程,并结合相关文献讨论腔镜下钬激光治疗上尿路结石失败原因及其对策。结果4例严重的并发症分别为2例肾破裂致大出血,1例严重感染、休克及播散性血管内凝血(disseminated intravascular coagulation,DIC)致死亡及1例输尿管镜术后出血并感染。结论腔镜下钬激光治疗上尿路结石失败的主要原因包括:①组织结构的变异、结石、炎症等;②其他因素给手术带来的困难;③没有进行严格的病例选择;④术者临床经验不足。故术前应充分考虑影响上尿路腔镜下钬激光治疗结石的不利因素,掌握其手术的适应证及并发症,并拟出相应对策,以提高其治愈率。
Objective With the wide application of endoscopic technique in the treatment of upper urinary tract calculi, intraoperative and postoperative bleeding, severe infections, shock and even deaths also occur from time to time. To seek and accumulate endoscopic holmium laser treatment of upper urinary tract stones experience to further improve the cure rate. Methods The diagnosis and treatment of 4 cases of serious complications since Holmium laser lithotripsy were reviewed. The causes of failure of endoscopic Holmium laser lithotripsy and its countermeasures were discussed in combination with related literatures. Results Four cases of serious complications were severe renal hemorrhage (2 cases), severe infection (1 case), death due to shock and disseminated intravascular coagulation (DIC), and bleeding and infection after ureteroscopy. Conclusions The main causes of the failure of endoscopic holmium laser in the treatment of upper urinary tract calculi include: ①variation of tissue structure, calculi and inflammation; ② difficulties caused by other factors; ③ no strict case selection; ④clinical Lack of experience. Therefore, the full consideration should be given before surgery of upper urinary tract endoscopic holmium laser lithotripsy unfavorable factors, to master the indications and complications of surgery, and to develop appropriate countermeasures to improve the cure rate.