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目的报告经尿道和经皮肾途径输尿管镜下钬激光治疗输尿管嵌顿性结石并输尿管息肉的经验与疗效。方法2000年8月～2006年9月应用输尿管镜钬激光碎石息肉消融术经尿道和经皮肾途径治疗69例嵌顿性输尿管结石并息肉,术后4～6周拔除输尿管内支架管,术后3～6个月泌尿系B超和/或静脉肾盂造影对术后情况进行复查和随访。结果47例行经尿道输尿管镜钬激光碎石息肉消融术治疗,其中38例一期手术获得成功,术中因输尿管穿孔改开放手术2例,4例输尿管上段结石因输尿管扭曲输尿管镜无法到达输尿管梗阻部位,改经皮肾途径手术成功,3例术后尿路造影提示病变处输尿管碎石颗粒聚积,二期经尿道输尿管镜钬激光治疗后治愈;经皮肾输尿管镜钬激光碎石息肉消融术治疗22例,均一期手术获得成功。术后随访患肾积水均有改善,患侧输尿管引流正常,未发生输尿管狭窄和息肉复发。结论经尿道和经皮肾输尿管镜下钬激光碎石息肉消融术治疗嵌顿性输尿管结石并息肉是一种可靠而有效的方法;处理合并输尿管上段包裹性息肉时,经皮肾途径无论是在操作安全性和结石取净率上较经尿道途径更为优越。
Objective To report the experience and efficacy of transurethral and percutaneous renal ureteroscopic holmium laser for the treatment of ureteral incarcerated stones and ureteral polyps. Methods From August 2000 to September 2006, ureteroscopic holmium laser lithotripsy and polyp ablation were used to treat 69 cases of incarcerated ureteral calculi and polyps via urethral and percutaneous nephrectomy. Ureteral stent was removed 4 to 6 weeks after operation, Postoperative 3 to 6 months urinary tract ultrasound and / or intravenous pyelography postoperative review and follow-up. Results 47 cases were treated by transurethral ureteroscopic holmium laser lithotripsy and polyp ablation. Among them, 38 cases were successfully operated in the first stage, 2 cases were opened due to perforation of the ureter during operation, 4 cases of upper ureteral calculi could not reach the ureter due to ureter distorted ureteroscope Obstructive site, transcutaneous nephrotic surgery was successful, 3 cases of postoperative urography showed lesions of ureteral gravel particles accumulate, two urethral ureteroscopic holmium laser treatment after cure; percutaneous nephrolithotomy holmium laser gravel polyps ablation Twenty-two cases were treated by surgery, and the surgery was performed successfully. Follow-up of patients with hydronephrosis have improved, ipsilateral ureter drainage is normal, no ureteral stricture and recurrence of polyps. Conclusions Transurethral and percutaneous nephrolithotomy with holmium laser lithotripsy and polyp ablation for the treatment of incarcerated ureteral calculi and polyps is a reliable and effective method. In the treatment of parietal polyps with the upper ureter, the percutaneous renal approach Operational safety and stone removal rate than the transurethral approach is more superior.