输尿管镜钬激光碎石术治疗输尿管中下段结石的疗效分析

王保平 毕金文 周亮亮 孙立征 杨晶 刘雪欢

摘要：目的 探讨输尿管镜钬激光碎石术治疗输尿管中下段结石的手术技巧和临床效果。方法 回顾性分析2016年1月至2021年1月于我院采用输尿管硬镜钬激光碎石治疗输尿管中下段结石1286例患者的临床资料，左侧620例，右侧644例，双侧22例。钬激光能量0.8～1.5J，脉冲频率10～30Hz，采用蚕食法，从结石周边向中央碎石治疗，将结石粉碎成直径<3mm颗粒。结果 1258例一次碎石成功，成功率97.8%（1258/1286），进镜失败9例，留置双J管1周后手术治疗成功。15例结石进入肾盂，12例改行输尿管软镜钬激光碎石术，3例术后行体外冲击波碎石术;合并输尿管狭窄3例，2例行腹腔镜下输尿管切开取石、输尿管成形术，1例行开放手术;输尿管断裂1例，行输尿管膀胱再植术;手术时间（45.3±20.1min）（20～95min），术后住院时间4.3±1.5d（3～6d）。随访3～12个月，平均6个月，1254例结石完全排出，结石残留4例，行二次手术后治愈，输尿管末端闭锁2例，行腹腔镜输尿管膀胱再植术。结论 输尿管镜钬激光碎石术治疗输尿管中下段结石安全、微创、疗效可靠。

关键词：输尿管结石;输尿管镜;钬激光

Analysis of ureteroscopic holmium laser lithotripsy in the treatment of lower ureteral stones

Wang Baoping， Bi Jinwen， Zhou Liangliang， Sun Lizhong， Yang Jing， and Liu Xuehuan

（Urology Department， Beijing Huairou Hospital，101400）

[Abstract] Objective To investigate the surgical technique and clinical effect of ureteroscopic holmium laser lithotripsy in the treatment of lower ureteral calculi.Methods The clinical data of 1286 patients were 620 patients and 22 patients from January 2016 to January 2021.Holmium laser energy 0.8～1.5J， with a pulse frequency of 10 to 30 H z， was treated from the periphery of the stone to the central rubble， and the stone was crushed into particles <3mm in diameter.Results 1，258 patients had successful single lithotripsy， with a success rate of 97.8% （1258 / 1286）， 9 cases of endoscopic failure， and successful surgical treatment after 1 week of indwelling double J tube.Fifteen stones were admitted into the renal pelvis， 12 underwent ureteroscopic holmium laser lithotripsy， 3 postoperative shock wave lithotripsy， 3 combined ureteral strictures， 2 laparoscopic ureterostrictomy， 1 routine open surgery， 1 ureteral bladder replantation; surgical time （45.3±20.1min） （20-95 m i n） and postoperative hospitalization 4.3±1.5d （3-6 d）.Follow-up from 3 to 12 months， with an average of 6 months， 1，254 stones were completely discharged， 4 stones remained， cured after secondary surgery， 2 ureteral end atresia， and laparoscopic ureteral bladder replantation was performed.Conclusion The holmium laser lithotripsy is safe， minimally invasive and reliable.

[Keywords] ureteral stones; ureteroscopy; holmium laser

【中圖分类号】R364.2+5  【文献标识码】A  【文章编号】1673-9026（2021）14--01

输尿管结石的治疗方法有药物治疗、体外冲击波碎石（extracorporeal shock wave lithotripsy，ESWL）、输尿管镜碎石（ureteroscopic lithotripsy，URL）、腹腔镜输尿管切开取石术和开放手术取石。随着腔内碎石器械的飞速发展及腔镜手术操作水平的不断提高，输尿管镜下钬激光碎石凭借其微创、效率高、残石率低等优点，已成为当前临床治疗输尿管中、下段结石的“标准术式”{1-3]。2016年1月至2021年1月，我院应用输尿管镜钬激光碎石治疗输尿管中、下段结石1286例，疗效满意，报告如下。……