目的：探讨输尿管软镜钬激光碎石术治疗上尿路结石的临床疗效。方法：采用输尿管软镜钬激光碎石术治疗上尿路结石80例，共有结石115枚，结石大小0.6~2.2 cm，平均（1.19±0.25）cm。先用输尿管硬镜探查患侧输尿管，留置导丝，顺导丝置入输尿管扩张鞘，置入输尿管软镜找到结石，以200μm钬激光光纤、0.8~1.2 J/8~10 Hz功率碎石。常规留置5F DJ管。术后第一天复查KUB了解结石残留情况及DJ管位置。残石≤3 mm视为碎石成功。结果：输尿管扩张鞘一次置入率90.0％（72/80），结石寻及率94.8％（109/115），单次碎石成功率91.3％（105/115）。手术失败者2例为下盏结石，1例为中盏结石合并盏颈口明显狭窄，1例为输尿管结石合并中盏结石，输尿管碎石后尿色较红，终止手术。手术时间35~96 min，平均58 min，术后住院2~5 d，平均3.4 d。术后2~3 d拔除尿管，1个月拔除双J管。无输尿管穿孔、输尿管黏膜脱套、尿源性败血症等并发症。结论：输尿管软镜钬激光碎石术对肾盂结石、肾盏结石及输尿管上段结石安全有效。%Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for upper urinary tract calculi. Method 80 cases of renal and upper ureter calculi(sized between 6 to 22mm in diameter,115 calculi in to-tal)were treated by flexible ureteroscopy with Holmium laser lithotripsy in our hospital. The ureteral lumen was observed and di-lated by a rigid ureteroscopy,then a ureteral access sheath was placed. Holmium laser lithotripsy was performed by a Wolf flexible ureteroscopy. The power of the laser was 0. 8~1. 2J/8~10 Hz. A F5 DJ stent was regularly input. KUB was performed 1 day post operation to detect the position of DJ stent and the result of lithotripsy. Lithotripsy was considered successful when the diameter of the residual calculi was not bigger than 3 mm. Results The insertion of flexible ureteroscopy was successful in 90. 0%( 72/80 ) in the first time. The calculi were detected in 94. 8%(109/115),and laser lithotripsy succeeded in 91. 3%(105/115). The aver-age operation time was 58 minutes(35~96 min). The average postoperative hospitalization was 3. 4 d(2~5 d). No serious com-plication was observed. Conclusion Flexible ureteroscopy combined holmium laser lithotripsy is safe and effective for upper uri-nary tract calculi.
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