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目的探讨输尿管镜下套石篮联合钬激光治疗输尿管上段结石的可行性和有效性。方法对168例输尿管上段结石患者采用输尿管镜下套石篮联合钬激光治疗。结石距离肾门1～8cm。同侧肾无积水17例,轻度积水63例,中度积水58例,重度积水30例。结石周围有息肉包裹47例,结石大小约0.5cm×0.6cm～1.9cm×1.2cm,平均大小约1.2cm×0.8cm。结果 168例患者均顺利完成手术,未出现输尿管黏膜撕脱,输尿管断裂,感染性休克,漏尿等并发症。1例输尿管部分穿孔,3例患者虽有直径超过0.3cm结石上移到肾上盏,通过套石篮成功取出,有5例患者碎石取石过程中部分直径超过0.3cm结石上移到肾中下盏未能取出,总碎石取石成功率97.0%(163/168)。手术时间16～79min,平均36min。术后住院时间1～5d,平均2d。结论输尿管镜下套石篮联合钬激光治疗输尿管上段结石安全可行,碎石取石成功率高,值得推广。
Objective To investigate the feasibility and effectiveness of ureteroscopic stone basket combined with holmium laser in the treatment of upper ureteral calculi. Methods 168 cases of upper ureteral calculi patients underwent ureteroscopy stone basket combined holmium laser treatment. Stone from the kidney door 1 ~ 8cm. Ipsilateral renal hydronephrosis in 17 cases, 63 cases of mild hydrothorax, 58 cases of moderate hydronephrosis, severe hydrocephalus in 30 cases. 47 cases of polyps surrounded by stones, stones about 0.5cm × 0.6cm ~ 1.9cm × 1.2cm, with an average size of about 1.2cm × 0.8cm. Results 168 patients were successfully completed the operation, there was no ureteral mucosal avulsion, ureteral rupture, septic shock, leakage of urine and other complications. One case of ureter partially perforation, 3 patients although the diameter of more than 0.3cm stones on the kidney to the upper light, successfully removed through the stone basket, 5 patients with gravel in the process of part of the diameter of more than 0.3cm stone transferred to the kidney The next light failed to remove the total gravel stone success rate of 97.0% (163/168). Surgery time 16 ~ 79min, an average of 36min. Postoperative hospital stay 1 ~ 5d, an average of 2d. Conclusions Ureteroscopy combined with holmium holmium laser treatment of upper ureteral calculi is safe and feasible. The success rate of gravel stone removal is worthy of promotion.