输尿管镜下钬激光碎石治疗 ESWL 失败后复杂性输尿管结石（附74例分析）

摘要

Objective To evaluate the efficacy of the holmium laser lithotripsy under ureteroscope after ESWL. Methods Clinical data of 74 patients with ureteral calculi after ESWL treated with holmium laser lithotripsy under ureteroscope during Oct.2008 to Aug.2010 were retrospectively analyzed.Results The overal stone-free rate was 90.5% (67/74).The success rate was77. 8% (14/18) in the upper segment, 91.7% (22/24)in themiddle segment, and 97.9% (31/32) in the lower segment. The procedure failed in 7 patients.The D-J stent was placed after opertion,the time was 2-4 weeks. Hospital stay after operation was 3.9days. Conclusion The difficult of the holmium laser lithotripsy under ureteroscope after ESWL for ureteral calculi.To enhanced operaton skil, the success rate wl be increased.%　　目的：探讨 ESWL 失败后的复杂性输尿管结石采用输尿管镜联合钬激光碎石的可行性。方法：回顾性分析2008年10月至2012年8月间 ESWL 治疗失败后的输尿管结石患者在我院应用输尿管镜联合钬激光碎石治疗共计74例患者临床资料。结果：74例患者中明显炎性息肉包裹性结石37例，结石下方输尿管明显扭曲狭窄10例，其余患者结石周围输尿管粘膜均有不同程度水肿。手术成功率90.5%(67/74)，其中上段结石为77.8%(14/18)，中段为91.7%(22/24)，下段为97.9%(31/32)。失败7例。术后常规留置双 J 管2-4周。定期复查拔出双 J 管。术后住院时间分别为3.9天。结论：ESWL 失败后输尿管镜联合钬激光碎石手术难度增加，提高操作技巧，可以显著提高治疗输尿管镜碎石成功率。