腔内钬激光碎石术治疗输尿管、膀胱结石
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摘要
目的：探讨腔镜下钬激光碎石术治疗输尿管结石、膀胱结石的疗效及安全性。
方法：山东大学齐鲁医院泌尿外科2004年6月～2006年9月，经输尿管镜或膀胱镜下钬激光治疗输尿管、膀胱结石89例。直接经尿道插入输尿管镜或膀胱镜，直达结石位置，设置能量为0.5～1.5J／5～15HZ，自镜身操作腔插入光纤，击碎结石，合并息肉或狭窄者行汽化切割或切开，术后留置双J管2～4周，尿管1～3天。行钬激光前列腺剜除术的病例，留置三腔气囊导尿管，1周后拔除。
结果：13例膀胱结石和3例后尿道结石均一次碎石成功，碎石成功率100％。膀胱结石碎石时间20分钟～210分钟，平均55分钟；后尿道结石碎石时间10分钟～90分钟，平均40分钟。73例输尿管结石中，69例一次碎石成功，碎石成功率94.5％，手术时间15分钟～150分钟，平均44分钟。术后3例发热(3.4％)，所有病例均无输尿管或膀胱穿孔、输尿管撕裂等严重并发症发生。
结论：钬激光结合腔镜治疗输尿管、膀胱结石安全、高效。
Objective To evaluate the clinical effect of holmium laser lithotripsy under ureteroscope or cystoscope for the treatment of ureteral and bladder calculi.
Method A total of 89 cases of ureteral or bladder calculi were treated with holmium laser kithotripsy under ureteroscope or cystoscope between June 2004 to September 2006 in department of urology of Qilu Hospital of Shandong University.With energy 0.5～1.5J/5～15HZ ,the ureteroscope or cystoscope was directly inserted into the urethra with its tip reaching the caculus . Then the optical fiber was introduced to deliver holmium laser pulse to the calculus until it was
fragmented .Accompanied polyps or stricture were treated with holmium laser vaporization or ablation at the same time . Postoperatively, the double-J tube drainage time was 2-4 weeks and the indwelling catheter was 1-3 days. In cases treated with holmium laser enucleation of prostate, a standard three -cavity catheter was placed and was removed 1 week postoperatively.
Result 13 cases of bladder stone and 3 cases of posterior urethral stone were successfully fragmented after a pressing session, success rate 100%. The operation time of bladder stone was 20-210 min (mean, 55 min); the operation time of posterior urethral stone was 10-90 min (mean, 44 min). The overall successful stone fragmentation rate of ureteral calculi was 94.5% (69/73), the operation time of ureteral calculi was 15-150 min (mean 44 min).Postoperative pyrexia occurred in 3 cases(3.4%). No major complications such as uretera and bladder perforation were
encountered.
Conclusion Endoluminal holmium laser lithotripsy is an effective and safe method
for uretera and bladder stone.
方法：山东大学齐鲁医院泌尿外科2004年6月～2006年9月，经输尿管镜或膀胱镜下钬激光治疗输尿管、膀胱结石89例。直接经尿道插入输尿管镜或膀胱镜，直达结石位置，设置能量为0.5～1.5J／5～15HZ，自镜身操作腔插入光纤，击碎结石，合并息肉或狭窄者行汽化切割或切开，术后留置双J管2～4周，尿管1～3天。行钬激光前列腺剜除术的病例，留置三腔气囊导尿管，1周后拔除。
结果：13例膀胱结石和3例后尿道结石均一次碎石成功，碎石成功率100％。膀胱结石碎石时间20分钟～210分钟，平均55分钟；后尿道结石碎石时间10分钟～90分钟，平均40分钟。73例输尿管结石中，69例一次碎石成功，碎石成功率94.5％，手术时间15分钟～150分钟，平均44分钟。术后3例发热(3.4％)，所有病例均无输尿管或膀胱穿孔、输尿管撕裂等严重并发症发生。
结论：钬激光结合腔镜治疗输尿管、膀胱结石安全、高效。
Objective To evaluate the clinical effect of holmium laser lithotripsy under ureteroscope or cystoscope for the treatment of ureteral and bladder calculi.
Method A total of 89 cases of ureteral or bladder calculi were treated with holmium laser kithotripsy under ureteroscope or cystoscope between June 2004 to September 2006 in department of urology of Qilu Hospital of Shandong University.With energy 0.5～1.5J/5～15HZ ,the ureteroscope or cystoscope was directly inserted into the urethra with its tip reaching the caculus . Then the optical fiber was introduced to deliver holmium laser pulse to the calculus until it was
fragmented .Accompanied polyps or stricture were treated with holmium laser vaporization or ablation at the same time . Postoperatively, the double-J tube drainage time was 2-4 weeks and the indwelling catheter was 1-3 days. In cases treated with holmium laser enucleation of prostate, a standard three -cavity catheter was placed and was removed 1 week postoperatively.
Result 13 cases of bladder stone and 3 cases of posterior urethral stone were successfully fragmented after a pressing session, success rate 100%. The operation time of bladder stone was 20-210 min (mean, 55 min); the operation time of posterior urethral stone was 10-90 min (mean, 44 min). The overall successful stone fragmentation rate of ureteral calculi was 94.5% (69/73), the operation time of ureteral calculi was 15-150 min (mean 44 min).Postoperative pyrexia occurred in 3 cases(3.4%). No major complications such as uretera and bladder perforation were
encountered.
Conclusion Endoluminal holmium laser lithotripsy is an effective and safe method
for uretera and bladder stone.
引文
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