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目的:探讨经尿道输尿管镜钬激光治疗输尿管中下段结石的疗效及技巧。方法:回顾总结2013年8月~2015年5月采用输尿管镜钬激光治疗输尿管中下段结石330例患者临床资料,下段结石212例,中段结石118例。330例患者中61例为ESWL治疗失败后,在斑马导丝的引导下,采用直接挑起进镜法或翻转180°进镜法顺利将输尿管镜置入患侧输尿管,采用“蚕食法”或“钻孔法”碎石,镜下以钬激光光纤头为参照物,将结石逐步击碎至最大径为2mm以下。结果:330例中一次碎石成功322例,失败8例;手术时间为25~110min(平均45.23min),住院时间5~9d(平均5.6d);术后45例出现肉眼血尿,12例出现轻度发热,经对症治疗后症状消失;术后随访4周结石排净率为94.55%(312/330),随访6周结石排净率为100%。结论:经尿道输尿管镜钬激光治疗输尿管中下段结石安全可靠,具有疗效肯定,创伤小,恢复快,住院时间短等特点。掌握好输尿管镜的使用方法及技巧能提高碎石效率及成功率。
Objective: To investigate the efficacy and skills of transurethral ureteroscopic holmium laser in the treatment of lower ureteral calculi. Methods: From August 2013 to May 2015, we retrospectively analyzed the clinical data of 330 patients with lower ureteral calculi treated by ureteroscopic holmium laser. Among them, there were 212 cases of lower calculus and 118 cases of middle calculus. Among the 330 cases, 61 cases were treated with ESWL, and guided by zebra guidewire, the ureteroscope was successfully placed into the ipsilateral ureter with the method of directly provoking into the mirror or turning 180 ° into the mirror, “Or ” drilling method "gravel, the holmium laser fiber endoscope as the reference, the stone gradually crushed to a maximum diameter of 2mm or less. Results: Of the 330 cases, 322 cases were successfully graded in one time, 8 cases failed. The operation time was 25 ~ 110min (average 45.23min) and the hospitalization time was 5 ~ 9d (average 5.6d). Gross hematuria occurred in 45 cases and 12 cases Mild fever, symptoms after symptomatic treatment disappeared; 4 weeks after follow-up of stones discharged rate was 94.55% (312/330), follow-up of 6 weeks stone discharge rate was 100%. Conclusion: Transurethral ureteroscopic holmium laser is safe and reliable in the middle and lower ureteral calculi, which has the characteristics of definite curative effect, small trauma, rapid recovery and short hospital stay. Grasp the use of ureteroscope techniques and techniques can improve the efficiency and success rate of gravel.