输尿管软镜钬激光碎石术治疗体外冲击波碎石术失败的输尿管上段结石
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摘要
目的:评价输尿管软镜钬激光碎石术治疗体外冲击波碎石术(ESWL)失败的输尿管上段结石的疗效。方法:回顾性分析2013年6月～2017年6月我院采用输尿管软镜钬激光碎石术治疗ESWL失败的输尿管上段结石48例。结石最大直径为0.6～1.5 cm。手术方法首先将结石推入肾脏内,然后沿导丝直接置入纤维输尿管软镜到达肾盂,找到结石以200μm光纤和16 W功率钬激光碎石。结果:46例患者顺利一次性完成手术,手术成功率为95.83%。术后4周拔除双J管,2个月后复查B超和或平扫CT。37例结石全部排尽;7例复查有2～4 mm的小结石,无需再次行ESWL;2例残留结石直径>4 mm,但未接受进一步治疗。所有患者无输尿管穿孔及大出血等并发症发生。结论:输尿管软镜钬激光碎石术治疗ESWL失败的输尿管上段结石可安全有效地清除结石,尤其适用于结石体积较小和无明显肾积水的结石。可作为输尿管上段结石ESWL失败后的一种有效补救性治疗措施。
Objective: To evaluate the efficacy of flexible ureteroscopic lithotripsy with holmium laser for the treatment of proximal ureteral calculi ineffective by extracorporeal shock wave lithotripsy(ESWL). Method: Between June 2013 to June 2017, 48 cases with proximal ureteral calculi after failure of ESWL were treated with flexible ureteroscopic lithotripsy using holmium laser in our hospital. Their data were retrospectively analyzed. Result: Forty-six patients had undergone a flexible ureteroscopic lithotripsy successfully with a success rate of 95.83%. No significant complications developed, such as ureteral perforation or massive haemorrhage. Residual calculi lager than 4 mm were found in 2 patients, but they did not receive further managements. Conclusion: The flexible ureteroscopic lithotripsy with holmium laser is safe and effective for the treatment of small proximal ureteral calculi ineffective by ESWL.
Objective: To evaluate the efficacy of flexible ureteroscopic lithotripsy with holmium laser for the treatment of proximal ureteral calculi ineffective by extracorporeal shock wave lithotripsy(ESWL). Method: Between June 2013 to June 2017, 48 cases with proximal ureteral calculi after failure of ESWL were treated with flexible ureteroscopic lithotripsy using holmium laser in our hospital. Their data were retrospectively analyzed. Result: Forty-six patients had undergone a flexible ureteroscopic lithotripsy successfully with a success rate of 95.83%. No significant complications developed, such as ureteral perforation or massive haemorrhage. Residual calculi lager than 4 mm were found in 2 patients, but they did not receive further managements. Conclusion: The flexible ureteroscopic lithotripsy with holmium laser is safe and effective for the treatment of small proximal ureteral calculi ineffective by ESWL.
引文
1 Lopes Neto A C,Korkes F,Silva J L 2nd,et al.Prospective randomizedstudy of treatment of large proximal ureteral stones:extracorporealshock wave lithotripsy versus ureterolithotripsy versuslaparoscopy[J].J Urol,2012,187(1):164-168.
2 Basulto-Martínez M,Klein I,Gutiérrez-Aceves J.The role of extracorporeal shock wave lithotripsy in the future of stone management[J].Curr Opin Urol,2019,29(2):96-102.
3 黄建生,房洁群,余舟,等.输尿管软镜钬激光碎石术在>2 cm肾结石治疗中的应用体会[J].临床泌尿外科杂志,2019,34(5):264-267.
4 Picozzi S C,Ricci C,Gaeta M,et al.Urgent ureteroscopy as first-line treatment for ureteral stones:ameta-analysis of 681 patients[J].Urol Res,2012,40(5):581-586.
5 Wu T,Duan X,Chen S,et al.Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones:A Systematic Review and Meta-Analysis[J].Urol Int,2017,99(3):308-319.
6 Geraghty R M,Jones P,Herrmann T R W,et al.Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment:systematic review and meta-analysis[J].World J Urol,2018,36(11):1783-1793.
7 Cui X,Ji F,Yan H,et al.Comparison between extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy for treating largeproximal ureteral stones:a meta-analysis[J].Urology,2015,85(4):748-756.
8 桂志明,苏劲,柳建军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较[J].临床泌尿外科杂志,2017,32(1):61-64.
9 Xu G,Wen J,Li Z,et al.A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy[J].Int J Clin Exp Med,2015,8(3):4501-4507.
10 王俊,郭志新,吴洪磊,等.输尿管软镜钬激光碎石术治疗输尿管上段结石并发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2018,33(7):532-535.
11 Khoder W Y,Bader M,Sroka R,et al.Efficacy and safety of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi[J].BMC Urol,2014,14:62-62.
2 Basulto-Martínez M,Klein I,Gutiérrez-Aceves J.The role of extracorporeal shock wave lithotripsy in the future of stone management[J].Curr Opin Urol,2019,29(2):96-102.
3 黄建生,房洁群,余舟,等.输尿管软镜钬激光碎石术在>2 cm肾结石治疗中的应用体会[J].临床泌尿外科杂志,2019,34(5):264-267.
4 Picozzi S C,Ricci C,Gaeta M,et al.Urgent ureteroscopy as first-line treatment for ureteral stones:ameta-analysis of 681 patients[J].Urol Res,2012,40(5):581-586.
5 Wu T,Duan X,Chen S,et al.Ureteroscopic Lithotripsy versus Laparoscopic Ureterolithotomy or Percutaneous Nephrolithotomy in the Management of Large Proximal Ureteral Stones:A Systematic Review and Meta-Analysis[J].Urol Int,2017,99(3):308-319.
6 Geraghty R M,Jones P,Herrmann T R W,et al.Ureteroscopy is more cost effective than shock wave lithotripsy for stone treatment:systematic review and meta-analysis[J].World J Urol,2018,36(11):1783-1793.
7 Cui X,Ji F,Yan H,et al.Comparison between extracorporeal shockwave lithotripsy and ureteroscopic lithotripsy for treating largeproximal ureteral stones:a meta-analysis[J].Urology,2015,85(4):748-756.
8 桂志明,苏劲,柳建军,等.输尿管软镜钬激光碎石术与经皮肾镜取石术治疗输尿管上段大结石的疗效比较[J].临床泌尿外科杂志,2017,32(1):61-64.
9 Xu G,Wen J,Li Z,et al.A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy[J].Int J Clin Exp Med,2015,8(3):4501-4507.
10 王俊,郭志新,吴洪磊,等.输尿管软镜钬激光碎石术治疗输尿管上段结石并发输尿管狭窄的危险因素分析[J].临床泌尿外科杂志,2018,33(7):532-535.
11 Khoder W Y,Bader M,Sroka R,et al.Efficacy and safety of Ho:YAG laser lithotripsy for ureteroscopic removal of proximal and distal ureteral calculi[J].BMC Urol,2014,14:62-62.