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目的评价输尿管软镜下钬激光碎石术治疗上尿路结石的疗效及影响碎石成功率的因素和手术技巧。方法回顾分析2011年10月至2013年4月80例输尿管软镜钬激光碎石病例的临床资料。38例结石位于上盏、中盏或肾盂内,4例位于下盏,10例位于多个肾盏内,15例位于输尿管上段,13例同时位于肾盏和输尿管上段。均为单侧病变,结石最大直径均<25mm。术中使用输尿管硬镜探查患侧输尿管,放置输尿管导引鞘并换用Storz Flex-X2F7.5输尿管软镜。若输尿管鞘无法插入,可直接在导丝引导下插入输尿管软镜至肾盂。如果软镜仍不能直接插入,则在放置导丝后留置F6双J管,2周后第二次试行输尿管软镜碎石。术后4周复查肾输尿管膀胱摄影(KUB)或双肾CT平扫,评估碎石效果。结果软镜一次进镜成功率96.3%(77/80);3例输尿管硬镜进镜困难且无法直接插入软镜者,均在成功插入导丝后置入F6双J管,2周后再次尝试,均成功进镜。其中78例成功进行钬激光碎石,另2例结石位于下盏憩室内,软镜未找到结石。总的入镜成功率为100%(80/80),钬激光碎石成功率97.5%(78/80),平均手术时间55(30~120)min,结石清除率为87.5%(70/80),无严重并发症。结论输尿管软镜钬激光碎石是治疗上尿路结石安全有效的方法。其结石排净率高、并发症低,可以作为体外冲击波碎石失败和经皮肾镜碎石术后残留结石的治疗选择。
Objective To evaluate the efficacy of ureteroscopic holmium laser lithotripsy in the treatment of upper urinary tract calculi and the factors influencing the success rate of gravel and surgical techniques. Methods The clinical data of 80 cases of ureteroscopic holmium laser lithotripsy from October 2011 to April 2013 were retrospectively analyzed. Thirty-eight cases were located in the upper cup, middle cup or renal pelvis, 4 in the lower cup, 10 in multiple calyces, 15 in the upper ureter, and 13 in the upper calyx and ureter. All unilateral lesions, the largest diameter of stones are <25mm. Intraoperative ureteroscopic exploration of the ipsilateral ureter, ureter guiding sheath placed and replaced with Storz Flex-X2F7.5 ureteroscopy. If the ureteral sheath can not be inserted, guide the guide wire can be inserted directly under the ureteroscope to the renal pelvis. If the soft-lens still can not be inserted directly, place the F6 double J tube after placing the guide wire and the second trial of ureteroscopic lithotripsy after 2 weeks. Four weeks after operation, renal ureterocele (KUB) or double renal CT scan was performed to evaluate the effect of gravel. Results The success rate of one mirror-entry into the mirror was 96.3% (77/80). Three patients with ureteroscopic hard-mirror were difficult and could not insert soft lens directly. All of them were placed in F6 double J tube after successful insertion of guidewire. Try, are successful into the mirror. Among them, 78 cases were successfully treated with holmium laser lithotripsy, and the other 2 cases were located in the lower caliber diverticulum. No soft stones were found. The total success rate of enucleation was 100% (80/80), the success rate of holmium laser lithotripsy was 97.5% (78/80), the average operation time was 55 (30 ~ 120) min. The stone clearance rate was 87.5% (70/80) ), No serious complications. Conclusions Ureteroscopic holmium laser lithotripsy is a safe and effective method for upper urinary tract calculi. The high rate of stone discharge, low complication, can be used as the treatment of residual stone failure after percutaneous nephrolithotomy and residual stones after percutaneous nephrolithotomy.