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目的总结输尿管软镜联合钬激光治疗上尿路结石的临床疗效。方法对本院2015年9月至2017年10月收治的1033例上尿路结石患者采用输尿管软镜下联合钬激光治疗,2.5cm以下结石患者970例、>2.5cm结石患者63例。常规输尿管硬镜下探查患侧输尿管,留置超滑导丝,退出硬镜顺导丝置入输尿管扩张鞘,退出鞘芯及导丝,沿输尿管软镜工作通道置入200μm光纤及连接人工注水管道,钬激光功率为0.8-1.0J/10-20Hz,将调试好的软镜置入输尿管鞘,寻找结石并将其粉碎。术后留置双“J”管2-4周,拔除“J”管前复查KUB了解残石情况。输尿管扩张鞘只要能置入输尿管中段以上且软镜能上及结石部位视为置鞘成功,残石≤3mm视为碎石成功。结果输尿管扩张鞘一次性置入完成手术率97.8%(1010/1033)。结石≤2.5cm者一次碎石成功率93.0%(902/970),结石>2.5cm者,行1-4次(平均1.8)次软镜下碎石。手术时间10-90min,平均33min,住院时间2-7d,平均3.5d。术中出现输尿管穿孔5例,术后出现尿源性脓毒血症30例、脓毒性休克5例、术后肾周血症8例,术后恢复良好,无严重并发症及死亡病例。结论输尿管软镜钬激光碎石术对上尿路结石患者是一种安全、有效的方法。
Objective To summarize the clinical efficacy of ureteroscopic combined with holmium laser in the treatment of upper urinary tract calculi. Methods A total of 1033 patients with upper urinary tract calculi treated in our hospital from September 2015 to October 2017 underwent ureteroscopic combined holmium laser therapy. There were 970 patients with stones below 2.5cm and 63 patients with> 2.5cm stones. Conventional ureteroscopic exploration of the ipsilateral ureteral catheter indwelling superfilamentary guide wire, exit the rigid guide wire into the ureteral dilatation sheath, exit the sheath core and guide wire, along the ureteroscope working channel into the 200μm optical fiber and the connection of artificial injection pipe , Holmium laser power 0.8-1.0J / 10-20Hz, will be good debugging soft mirror into the ureteral sheath, looking for stones and crush it. Postoperative double “J ” tube 2-4 weeks, unplug “J ” tube review KUB understand the situation of residual stone. Ureteral dilatation sheath as long as the ureter can be placed in the middle of the above and the soft mirror and stones can be regarded as sheath placement success, residual stone ≤ 3mm as gravel success. Results One-time ureteral dilatation and sheath insertion rate was 97.8% (1010/1033). Patients with stones ≤2.5cm had a successful rate of 93.0% (902/970) for gravels, stones> 2.5cm, and 1-4 times (mean 1.8) soft-lens lithotripsy. Surgery time 10-90min, an average of 33min, hospital stay 2-7d, an average of 3.5d. There were 5 cases of ureter perforation during surgery, 30 cases of urinary sepsis, 5 cases of septic shock and 8 cases of postoperative nephrotoxicity. Postoperative recovery was good without serious complications and deaths. Conclusions Ureteroscopic holmium laser lithotripsy is a safe and effective method for upper urinary tract calculi.