| 摘要: |
| 目的 探讨采用F8组合式输尿管软镜联合钬激光碎石术处理上尿路结石的临床价值。方法 上尿路结石患者33例,其中左侧结石26例,右侧结石7例；阴性结石1例。包括输尿管上段结石14例,输尿管合并肾上盏、中盏、下盏结石各1例,肾上盏结石1例,肾中盏结石2例,肾下盏结石5例,肾盂结石8例。最大结石直径0.6~2.3 cm。全麻或脊麻下,截石位,先将F8/9.8号输尿管硬镜置入输尿管内行直视下扩张。退出输尿管硬镜,沿导丝置入F12/14软镜输送鞘,随后置入F8 “铂立”软镜进入肾盂内进行钬激光碎石。术后常规留置F6 D-J管4周,留置导尿1~7 d。术后第1天行腹部平片（KUB）检查碎石情况及D-J管位置,部分病例术后2~4周复查KUB,对残留结石直径＞6 mm者进一步结合体外冲击波碎石术(ESWL)治疗。结果 27例（27/33例）病例均顺利碎石,单次碎石成功率81.8%,手术时间25~75 min。术中出血量少,术后有2例出现低热,无明显的输尿管损伤穿孔、术后高热、败血症等情况。其余6例病例中,1例因合并输尿管上段息肉水肿,进镜后因肾盂内血块较多无法碎石,改行ESWL碎石成功；1例因输尿管扭曲狭窄无法进镜改经皮肾穿刺取石术(PCNL)；2例肾下盏结石因下盏漏斗-肾盂夹角过小无法碎石改行ESWL后1例成功碎石,另1例因结石过硬,结石残留；2例因输尿管狭窄留置D-J管2周后第2次行输尿管软镜顺利碎石。结论 采用F8组合式输尿管软镜处理上尿路结石安全、方便、疗效可靠,尤其在处理输尿管上段结石和肾盂及肾中盏、上盏结石上疗效显著。 |
| 关键词: 组合式输尿管软镜 钬激光 碎石术 尿路结石 |
| DOI：10.3724/SP.J.1008.2011.01108 |
| 投稿时间：2011-09-26修订日期：2011-10-12 |
| 基金项目: |
|
| Clinical effectiveness of modular flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi: a report of 33 cases |
| HUANG Yun-teng1*,GU Si-ping2,JIAO Yang1,QI Jun1 |
(1. Department of Urology, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
2. Micro-Invasive Surgery Center, Huaqiao Hospital of Shishi City, Shishi 362700, Fujian, China
*Corresponding author.) |
| Abstract: |
| Objective To evaluate the clinical value of modular flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi. Methods A total of 33 patients with upper urinary tract calculi, including 22 males and 11 females, aging 20-86, were recruited in the present study. Fourteen patients were with upper ureteral calculi, 1 with ureteral and upper calyx calculi, 1 with ureteral and middle calyx calculi, 1 with ureteral and lower calyx calculi, 1 with upper calyx calculi, 2 with middle calyx calculi, 5 with lower calyx calculi, and 8 with pelvis calculi. Twenty-six patients had left calculi and 7 had right calculi; one patient had negative calculi. The diameter of the calculi ranged 0.6-2.3 cm. The patients were under general or spinal anaesthesia and at cutting stone position. After dilating the ureter, we inserted the guide wire under the vision of F8/9.8 rigid ureteroscope, then F12/14 flexible ureteral access sheath. Finally, holmium laser lithotripsy was performed by F8.0 “Polyscope” modular flexible ureteroscope. The power of the laser was 1.0 J and frequency was 10-20 Hz. F6 D-J tube was regularly input for 4 weeks post-operation, and Forley-urethral tube was input for 1 to 7 days. KUB was performed 1 day post-operation to detect the result of lithotropsy and the position of Double-J tube (in some patients, KUB was performed 2-4 weeks post-operation). If more than 6mm residual stone was detected, ESWL was performed.Results Lithotripsy was performed successfully in 27 patients (27/33); the operation time was 25-75 min (averagely 38 min); and the bleeding in the operation was less. Two patients had low fever post-operation; there were no ureteral perforation, high fever or septicaemia. The success rate of one-time lithotripsy was 82%. In the other 6 patients (6/33), 1 patient was transferred to ESWL due to polypi around the stone; 1 was transferred to PCNL due to ureter stricture,2 were transferred to ESWL due to small angle of lower calyx and pelvis, and 2 were transferred to URS due to ureter stricture.Conclusion F8 modular flexible ureteroscope is safe, convenient, and effective for lithotripsy of the upper tract calculi, especially for upper ureteral, pelvis, middle calyx, upper calyx stones. |
| Key words: combined flexible ureteroscope holmium laser lithotripsy urinary calculi |
