经尿道输尿管硬镜钬激光处理L4以上输尿管结石一期高碎石率

摘要

目的:总结经尿道输尿管硬镜钬激光处理L4以上输尿管结石一期高碎石率经验.方法:回顾性分析2011年12月~2016年6月,通过改良术中技巧方式,采用经尿道输尿管硬镜钬激光处理L4以上输尿管结石261例(269侧)患者资料,其中结石距肾盂输尿管交界处>4 cm者184例,结石距肾盂输尿管交界处≤4 cm者85例,测量结石最大径0.8~1.8 cm,平均(1.2±0.2)cm,集合系统分离12~50 mm,平均(20±4)mm.结果:结石距肾盂输尿管交界处>4 cm者184例,一期手术成功168例,结石清除率为91.3%,2例输尿管N形扭曲,改经皮肾碎石取石,14例碎石不完全,残余结石需要体外冲击波碎石(ESWL)治疗;结石距肾盂输尿管交界处≤4 cm有85例,一期手术成功64例,结石清除率为75.3%,5例输尿管N形扭曲,改经皮肾碎石取石,16例碎石不完全,残余结石需要ESWL治疗.结论:L4以上输尿管结石在考虑术前检查及术中操作细节情况下,在经尿道输尿管镜下达到高的碎石成功率,是对患者损伤小、操作方便、耗时短、相对经济的手术方式,可以作为优选方案.%Objective: To summarize the experiences of treatment of the patients with the 1st-stage of ureteral calculus above L4 with a high lithotripsy rate by trans-urethral ureteroscopy holmium laser.Methods: 269 cases of ureteral calculus who were treated by trans-urethral ureteroscopy holmium laser through a modification of intraoperative technique from Dec.2011 to Jun, 2016 were retrospectively analyzed, among them, there were 184 cases whose calculus was more than 4 cm away from the pelvis-ureter junction, and 85 cases whose calculus was equal to or less than 4 cm away from the pelvis-ureter junction.The maximum diameter of calculus was measured as 0.8-1.8 cm, averagely (1.2±0.2) cm, and collective systematic separation was 12-50 mm, averagely (20±4) mm.Results: There were 184 cases whose calculus was more than 4 cm away from the pelvis-ureter junction, and 168 cases were successfully cured by one-stage operation with the calculus clearance rate being 91.3%.There were 2 cases of N-shaped ureteral distortion, which were changed to receive a percutaneous renal lithotripsy to remove the calculus.There were 14 cases whose calculus was incompletely removed, and the remaining calculus needed to be treated by extracorporeal shock wave lithotripsy (ESWL).There were 85 cases whose calculus was equal to or less than 4 cm away from the pelvis-ureter junction, and 64 cases were successfully cured by one-stage operation with the calculus clearance rate being 75.3%.There were 5 cases of N-shaped ureteral distortion, which were changed to receive a percutaneous renal lithotripsy to remove the calculus.There were 16 cases whose calculus was incompletely removed, and the remaining calculus needed to be treated by ESWL.Conclusions: A high calculus clearance rate can be achieved by the trans-urethral ureteroscopy with a consideration of preoperative examination and intraoperative operational details in treating the L4-above ureteral calculus, which can be regarded as a preferential program characterized with less injury, convenient operation, short duration and relatively low cost.