Objective To evaluate the efficacy and safety of flexible ureteroscope combined with Holmium laser for treatment of upper urinary calculi, and to analyze the influencing factors of the success rate of lithotripsy. Methods Sixty-three patients with upper urinary calculi were enrolled in the study, with the stone size ranged from 10-20 mm in diameter (14 mm in average), including 30 patients of upper ureteral calculi, 6 of upper calyx calculi, 5 of middle calyx calculi, 4 of lower calyx calculi, 12 of pelvis calculi, and 6 of multiple calyx calculi. The 220 urn Holmium laser lithotripsy was performed by flexible ureteroscope. The power of the laser was 0.8-1.5 J and frequency was 10-15 Hz. A follow-up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the result of the endoscopic nephrolithotripsy. Results The total successful pulverization rate of stone was 98.4% (61/62), and the successful rate for the lower calyx stones was 66.7% (in 2 of the 3 patients, the stone was not found during operation in one patient). The total evacuation rate of the calculi was 87.3% (55/63). For the calculi in the upper or middle pole or in the renal pelvis, the complete evacuation rate was 91.5% (54/59), which was significantly higher than that for the lower pole (25.0%). No serious complications were found, such as ureter perforation, avulsion and hemorrhage. Conclusion The flexible ureteroscope and Holmium laser lithotripsy is safe and effective for upper urinary calculi sized less than 20 mm in diameter, especially for those in the upper and middle poles and renal pelvis.%目的 评价输尿管软镜结合钬激光处理上尿路结石的有效性、安全性,分析输尿管软镜碎石成功率的影响因素.方法 本组63 例,结石直径10~20 mm,平均14 mm.结石位于上盏6 例,中盏5 例,下盏4 例,肾盂12 例,多肾盏结石6 例,输尿管上段结石30 例.应用200 μm光纤0.8`1.5 J/10~15 Hz功率钬激光碎石.4 周后复查KUB或尿路CT,评估结石排净率.结果 总碎石成功率为98.4% (61/62),下盏结石碎石成功率66.7%(2/3)(1 例下盏结石术中未寻及),总结石排净率为87.3% (55/63),输尿管上段、肾中上盏及肾盂内结石术后排净率为91.5% (54/59),肾下盏结石术后结石排净率为25.0% (1/4).无输尿管穿孔、撕脱及大出血等严重并发症.结论 输尿管软镜结合钬激光是处理直径<20 mm上尿路结石的安全有效的手段.肾上、中盏及肾盂内结石较肾下盏结石碎石成功率高、结石排净率高.
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