标题：输尿管软镜钬激光碎石术治疗上尿路结石63例

      作者：肖运政，周 琦，袁淦宁，何 冬，赵树华，熊 丽
    （深圳市西丽人民医院泌尿外科，广东 深圳 518055）

      卷次： 2013年24卷6期

      【摘要】 目的 评价输尿管软镜结合钬激光处理上尿路结石的有效性、安全性，分析输尿管软镜碎石成功
率的影响因素。方法 本组 63例，结石直径 10~20 mm，平均 14 mm。结石位于上盏 6例，中盏 5例，下盏 4例，
肾盂12例，多肾盏结石6例，输尿管上段结石30例。应用200 μm光纤0.8`1.5 J/10~15 Hz功率钬激光碎石。4周
后复查KUB或尿路CT，评估结石排净率。结果 总碎石成功率为 98.4% (61/62)，下盏结石碎石成功率 66.7%
(2/3)（1例下盏结石术中未寻及），总结石排净率为87.3% (55/63)，输尿管上段、肾中上盏及肾盂内结石术后排净
率为 91.5% (54/59)，肾下盏结石术后结石排净率为 25.0% (1/4)。无输尿管穿孔、撕脱及大出血等严重并发症。
结论 输尿管软镜结合钬激光是处理直径<20 mm上尿路结石的安全有效的手段。肾上、中盏及肾盂内结石较
肾下盏结石碎石成功率高、结石排净率高。

      【关键词】 输尿管软镜；钬激光；碎石术；尿路结石

      【中图分类号】 R699.4 【文献标识码】 A 【文章编号】 1003—6350（2013）06—0876—03


Clinical efficacy of flexible ureteroscope combined with Holmium laser in the treatment of upper urinary
calculi: a report of 63 cases.
XIAO Yun-zheng, ZHOU Qi, YUAN Gan-ning, HE Dong, ZHAO Shu-hua, XIONG Li.
Department of Urology, Xili People's Hospital, Shenzhen 518055, Guangdong, CHINA

【Abstract】 Objective To evaluate the efficacy and safety of flexible ureteroscope combined with Holmium
laser for treatment of upper urinary calculi, and to analyze the influencing factors of the success rate of lithotripsy.
Methods Sixty-three patients with upper urinary calculi were enrolled in the study, with the stone size ranged from
10~20 mm in diameter (14 mm in average), including 30 patients of upper ureteral calculi, 6 of upper calyx calculi, 5
of middle calyx calculi, 4 of lower calyx calculi, 12 of pelvis calculi, and 6 of multiple calyx calculi. The 220 μm Hol-
mium laser lithotripsy was performed by flexible ureteroscope. The power of the laser was 0.8~1.5 J and frequency
was 10~15 Hz. A follow-up by KUB or non-contrast CT scan was done 4 weeks after the procedure to evaluate the re-
sult of the endoscopic nephrolithotripsy. Results The total successful pulverization rate of stone was 98.4% (61/62),
and the successful rate for the lower calyx stones was 66.7% (in 2 of the 3 patients, the stone was not found during op-
eration in one patient). The total evacuation rate of the calculi was 87.3％ (55/63). For the calculi in the upper or mid-
dle pole or in the renal pelvis, the complete evacuation rate was 91.5% (54/59), which was significantly higher than
that for the lower pole (25.0%). No serious complications were found, such as ureter perforation, avulsion and hemor-
rhage. Conclusion The flexible ureteroscope and Holmium laser lithotripsy is safe and effective for upper urinary
calculi sized less than 20 mm in diameter, especially for those in the upper and middle poles and renal pelvis.

      【Key words】 Flexible ureteroscope; Holmium laser; Lithotripsy; Urinary calculi