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钬激光碎石术治疗输尿管结石126例

发布日期:2018-12-28 浏览次数[] 文章来源:网上收集

【摘要】    目的:探讨钬激光结合输尿管镜技术治疗输尿管结石的临床效果及并发症。方法:采用合肥科瑞达公司生产的HLM-1-30A钬激光治疗机及Wolf F8-9.8硬质输尿管镜对2005年3月至2006年10月126例输尿管结石患者进行碎石治疗。结果:一次碎石成功率达93.7%(118/126);其中上段结石85%(41/48),中段100%,下段97.7%(46/47);8例未成功,其中6例上段结石上移至肾脏,1例上段输尿管扭曲,1例输尿管口粘连置镜失败。结石上移主要发生于使用输尿管镜早期。术后d1 KUB检查无结石率达77.8%(98/126)其它均于2周内排净。并发症主要有输尿管穿孔2.4%(3/126),血尿100%,腰痛25.4%(32/126),结石上移4.8%(6/126),泌尿系感染6.3%(8/126)。结论:钬激光能安全,有效,快速治疗输尿管结石。使用钬激光技术进行碎石治疗时要求有较好的输尿管镜技术基础。

【关键词】  输尿管结石 钬激光 输尿管镜

  Clinical Application of Holmium Laser in Ureteral Calculus

  Abstract: Objective:To investigate the clinical effect and complication of Holmium laser in ureteral calculus. Method:Holmium laser(HLM-1-30A)lithotripsy were adapted to 126 cases of ureterral calculus between March 2005 to October 2006. Result:118 of 126 cases ureter stones completed stone fragmentation.Among them ,upper ureteral calculi(85%),middle ureteral calculi(100%),lower ureteral calculi(97.9%). 8 cases were abandoned, because of the stone migrations to the renal pelvis in early phase(6cases) and ureter twisting (1cases) and UO adherence (1 cases).In the 126 cases the stones were cleared off on the first postoperative day under KUB,the left stones were done among two weeks.The complication includes ureteral perforation (2.4%,3/126)haematuria (100%),lumbago (25.4%).Stone migration (4.8%) and urinary tract infection (6.3%).Conclusion: The application of Holmium laser in lithotripter is a safe and effective procedure.The indisposition caused by procedure of cystoscope,not by Holmium laser.The Holmium laser did not increase the risk.To use Holmium laser better and ureteroscope skill better.

  Key words:  Ureteral calculus;  Holmium laser;  Ureteroscope   

  2005年3月至2006年10月我们应用输尿管镜钬激光碎石术治疗126例输尿管结石患者,取得满意疗效,现报告如下:

  1  资料与方法

  1.1  临床资料:本组126例 男72例,女 54例,年龄17~68岁,平均45岁,输尿管上段48例,其中5例并发肾结石;输尿管中.下段78例。结石最大为2.1cm×1.2cm,最小为0.6cm×0.5cm。手术时间15~78min,平均26min,激光功率12~18周,平均术后住院时间为2.5d,有51例患者有一次至多次ESWL未成功的病史;35例合并有炎性息肉;72例合并同侧肾积水,全部患者术前均行KUB,IVP,B超或CT证实,术后d1复查KUB,根据情况2~4周复查KUB,B超或IVP观察排石情况;术后3个月复查B超或IVP。

  1.2  手术方法:在硬膜外阻滞麻醉下取截石位,采有WOLF8~9.8硬质输尿管镜,合肥科瑞达公司生产的HLM?1~30W钬激光治疗机,配电视影像监视系统,直视下将输尿管镜置入输尿管推进到结石部位,经操作通道插入钬激光光纤(400微米)直抵结石,设置参数将功率控制在10~18W范围内进行碎石,将结石粉碎成 3mm以下的碎块。碎石方法:对于较大结石,从一侧边缘开始逐步将结石一层一层粉碎,由下向上将结石打开一个通道,然后将镜体轻轻侧斜抵住结石上端,再由上向下逐步粉碎结石,如有较大结石屑上移,立即推镜追踪结石将其粉碎,再向下将剩余结石粉碎;对于由息肉引起管腔狭窄或结石粘连紧密时,同时将息肉粘连组织汽化。术后常规留置双“J”管2~8周,碎石过程中采有生理盐水冲洗。

上一篇:钬激光碎石与输尿管镜下气压弹道碎石治疗输尿管结石的几个建议研讨 下一篇:钬激光碎石术治疗输尿管阴性结石36例临床分析

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