【作者】 丁国栋；

【导师】 何学军；

【作者基本信息】 汕头大学 ， 泌尿外科学， 2010， 硕士

【摘要】 目的与背景：输尿管结石是泌尿系疾病中的常见病、多发病,输尿管结石常引起梗阻,进而导致肾积水,造成肾功能损害,需进行积极有效的治疗。输尿管镜下碎石术是治疗输尿管结石的重要方法之一,目前常用的腔内碎石技术有气压弹道和钬激光。输尿管镜下气压弹道碎石术具有易导致结石上移、不适用于软镜、不能处理息肉等缺点。20世纪90年代中期以来,钬激光技术的出现并被应用于治疗泌尿系结石,由于在其碎石时可同时处理息肉、不易导致结石上移等优点,逐渐被应用于临床。我院自2009年4月引进钬激光,并开始应用于治疗输尿管结石,取得了较好的临床效果。本研究目的在于比较钬激光与气压弹道碎石术治疗输尿管结石的有效性及安全性,同时总结输尿管镜下钬激光碎石术的临床经验。材料和方法：收集我院自2008年1月至2010年3月输尿管镜下钬激光(HL)与气压弹道碎石(PL)治疗输尿管结石病例的临床资料,其中PL组103例,HL组44例,通过统计分析两组的碎石成功率、术后并发症,探讨输尿管镜下钬激光碎石的安全性及有效性。结果：HL组平均手术时间为45min,平均术后住院时间为3.5d,PL组分别为39min、3.6d。HL组和PL组手术成功率分别为88.64%、81.55%。对于输尿管上段结石,HL组与PL组碎石成功率分别为100%、84.21%,差异有统计学意义(p<0.01)。对于中下段输尿管结石,HL组与PL组碎石率分别为96.55%、95.16%,差异无统计学意义(p>0.05)。HL组1例出现输尿管穿孔,改行开放性手术；PL组3例出现输尿管穿孔,1例改行开放性手术,2例留置输尿管支架管。两组均未出现输尿管撕裂等严重并发症。HL组4例输尿管结石合并息肉,均行息肉烧灼术。结论：输尿管镜下钬激光碎石术治疗输尿管结石是一种安全而有效的方法,尤其适用于合并息肉的输尿管结石病例。更多还原

【Abstract】 Objective and Background:Ureteral calculi is a common disease in urinary tract diseases, because ureteral calculi always can lead to ureter obstruction, and then lead to hydronephrosis and kidney damage, It needs active and effective treatment. Ureteroscope lithotripsy is an important way to treat ureteral stone, the current popular technologies are pneumatic lithotripsy (PL) and holmium laser(HL). But PL has some shortcomings. For example, it is easy to cause the stone to move to calyx, it can not be used in soft lenses and can not cure polyps. Since the mid-90s of the 20th century, holmium laser technology emerged and was used in the treatment of urinary stones. Since it.can deal with polyps, and not easy to cause the stone move, it has been used in clinical gradually. Holmium laser machine was first introduced to our hospital in April 2009, and used in the treatment of ureteral stones, this procedure was associated with a good outcome in our series. In this article we compare the therapeutic effect and safety of holmium laser lithotripsy (HL) with penumatic lithotripsy (PL) on the treatment of ureteral calculi, and summarize the clinical experience of ureteroscopic holmium laser lithotripsy. Materials and Methods:Clinical data of HL (44 cases) and PL (103cases) was collected from January 2008 to March 2009 and compared with statistical analysis in the stone success rate and complications, in order to know the safety and efficacy of holmium laser lithotripsy.Results:The average operation time was 45min, the average postoperative hospital stay was 3.5d in HL group, and 39min,3.6d in PL group. The success rate was reached 88.64% in HL and 81.55% in PL. In the proximal ureteral calculi patients, stones free rate was 100% in HL which is significantly increased compared with 84.21% in PL (p<0.01). in the middle and distal ureteral calculi, there is no significant differences in stones free rate between HL(96.55%) and PL (95.16%) (p>0.05) HL group 1 case had ureteral perforation, converted to open surgery, and there were 3 cases had ureteral perforation in PL group,1 case converted to open surgery, two cases of indwelling ureteral stents. No serious complication such as ureteral tear occurred in HL group and PL group. HL group had 4 cases with polypi, all to be cauterized.Conclusion:HL is a highly effective and safe method for managing ureteral calculi, especially for patients with polyps of the ureter stone.更多还原