【摘要】 目的探讨电子输尿管软镜联合钬激光碎石术治疗肾下盏结石的安全性、有效性。方法我院2011年9月~2013年8月采用电子输尿管软镜下钬激光碎石术治疗肾下盏结石35例。结石直径0.8~2 cm,平均1.3 cm。先将输尿管硬镜置入患侧输尿管,观察输尿管管腔情况并留置导丝,退出输尿管硬镜,将输尿管软镜外鞘沿导丝置入输尿管,将输尿管软镜直视下置入患侧输尿管至肾盂,观察肾盂及各肾盏,寻找到结石,术中使用200μm光纤,0.8~1.5 J/10~20 Hz(10~30W)功率碎石。将结石碎成<0.3 cm的碎石,对于较大结石使用套石网篮将结石取出。结果 31例均一期成功完成输尿管软镜碎石术,4例因输尿管腔较窄,输尿管软镜无法上行,留置双J管1~2周后再次行输尿管软镜手术成功。手术时间30~120 min,平均60 min。围手术期均未发生严重并发症。术后1~6个月随访,无泌尿系结石残留,或残留结石直径<3 mm。结论电子输尿管软镜数字图像清晰、视野放大,与钬激光联合治疗肾下盏结石安全、有效,值得在临床上推广使用。更多还原

【Abstract】 Objective To evaluate the efficacy and safety of electronic flexible ureteroscopy and holmium laser lithotripsy for lower caliceal calculi. Methods From September 2011 to August 2013,35 cases of lower caliceal calculi( 0. 8- 2 cm in diameter; average,1. 3 cm in diameter) were treated by electronic flexible ureteroscopy and laser lithotripsy in our hospital. A F 8. 0 /9. 8 rigid ureteroscope was inserted to observe and dilate the ureteral lumen. Through the rigid ureteroscope,we introduced a wire into the ureter. After removing the rigid ureteroscope,we inserted the outer sheath of flexible ureteroscopy into the ureter along the wire. Then, an Olympus electronic flexible ureteroscope was placed into the ureter and renal pelvis. The stones were fragmentized to less than 0. 3 cm by using 200-μm holmium laser( 0. 8- 1. 5 J /10- 20 Hz) and removed. Results A total of 31 operations were performed successfully. The flexible ureteroscope failed to reach lower renal calyces in 4 cases because of the stricture of ureteral lumen,and they received a second operation 1- 2 weeks after double J stent was retained. The operation time was 30- 120 min( average,60 min), with no severe perioperative complications. The follow-up of 1 to 6 months after operation showed no residual calculi. Conclusions Electronic flexible ureteroscopy can provide clear image and magnified view. Electronic flexible ureteroscopy combined with holmium laser lithotripsy is a safe and effective procedure for lower caliceal calculi.更多还原