经输尿管镜钬激光碎石术治疗泌尿系结石（附417例报告）

目的 探讨输尿管镜下钬激光碎石术治疗泌尿系结石的疗效。方法 采用输尿管镜下钬激光碎石术治疗泌尿系结石417例，其中肾结石43例，输尿管上段结石219例，输尿管下段结石198例，双侧输尿管结石27例，肾结石合并输尿管结石19例，膀胱结石8例，尿路结石1例。结果 钬激光碎石术的一次性碎石治疗后结石排净率为91％（378／417）。手术时间20～105min，平均51min；术后住院1～10天，平均5．3天；结石排净时间2～7周，平均3周。术中结石移位20例、输尿管穿孔6例、13例肾结石术中出血较多中途终止碎石术。结论 输尿管镜下钬激光碎石术治疗泌尿系结石具有安全、有效、并发症少的特点，是治疗泌尿系结石的一种可靠方法。     

钬激光碎石治疗输尿管结石96例临床分析

近年来腔镜技术的发展、泌尿系结石治疗方法的增多、碎石技术的不断改进,使输尿管镜下腔内碎石术成为治疗输尿管结石的安全有效的方法。钬激光是目前腔内碎石中最有效且广泛接受的腔内碎石装置。2008年6—12月,我们应用输尿管镜钬激光腔内碎石术治疗96例输尿管结石,效果满意,现报道如下。     

腔镜下钬激光碎石术治疗泌尿系结石136例体会

目的探讨钬激光碎石术治疗泌尿系结石的疗效。方法总结应用腔镜下钬激光碎石治疗136例泌尿系结石患者的临床资料（其中肾结石68例,输尿管结石57例,膀胱结石11例）。结果肾结石碎石成功率为95．6％,其中一期取石56例,二期取石9例;输尿管结石碎石成功率为96．5％;膀胱结石碎石成功率为100％。结论腔内钬激光碎石术是治疗泌尿系结石安全、有效的方法。     

钬激光碎石术治疗输尿管上段结石110例

目的观察经尿道钬激光碎石术治疗输尿管上段结石的临床疗效及安全性。方法利用VersapulseSelect钬激光机经输尿管肾镜治疗110例输尿管上段结石病人,并以130例接受气压弹道碎石术的病人作为对照。结果110例输尿管结石患者一次手术结石粉碎率为96.4%(106例),平均结石排净时间2.5周;平均手术时间和术后住院天数分别为22min及2d。术中无输尿管穿孔、撕裂等并发症。而气压弹道碎石组中上述各项指标分别为86.9%3.1周、4.5min和5d,均与钬激光组有明显差异。结论钬激光碎石是治疗泌尿系结石一种安全、有效的腔道泌尿外科碎石方法。     

输尿管镜钬激光联合两重双J管引流术处理ESWL治疗失败的输尿管结石

目的：评价输尿管镜钬激光碎石联合腔内两重双J管引流术处理ESWL治疗失败输尿管结石的临床疗效,并探讨其影响因素。方法：2005年1月～2010年6月对ESWL失败的21例输尿管结石患者行输尿管镜钬激光碎石术,碎石后置入两根双J管,术后常规留置2～4周后拔除。结石合并息肉形成的13例患者均同期采用钬激光汽化切割息肉。结果：21例输尿管结石行钬激光碎石成功率达95．2%（20／21）,手术时间10～70min,平均（40．4±10．3）min;术后住院时间1～7天,平均（3．1土1．2）天。结论：输尿管镜钬激光碎石联合腔内两重双J管引流术处理ESWL治疗失败输尿管结石是安全可行的,保证结石清除率的同时不增加并发症发生率。     

钬激光治疗泌尿系结石(附155例报告)

目的：探讨钬激光治疗泌尿系结石的疗效。方法：总结利用Versa Pulse Select钬激光机经输尿管镜或膀胱镜治疗155例泌尿系结石患者的临床资料。结果：8例肾结石和7例膀胱结石均1次碎石成功;140例输尿管结石患者单次手术结石粉碎率为95．7％（134／140）,平均结石排净时间2．5周;平均手术时间25min、平均术后住院天数2．5d。术中无输尿管穿孔、撕裂等并发症。结论：钬激光治疗泌尿结石是一种有效的腔道泌尿外科碎石方法。     

输尿管镜钬激光碎石术治疗输尿管结石(附312例报告)

目的探讨钬激光碎石术治疗输尿管结石的有效性及安全性。方法在2005年10月至2007年4月采用钬激光碎石术治疗输尿管结石312例。其中输尿管上段结石94例,中、下段结石218例。结果碎石成功率为92.6%(289/312),其中上段结石成功粉碎率为81.9%(77/94),中下段结石为96.3%(210/218)。患者手术时间10～120min,平均手术时间(53.4±23.6)min,住院天数3～8d,平均住院(5.4±1.5)d。3例因输尿管严重扭曲无法进镜而中转开放,5例出现泌尿系感染。无1例出现输尿管穿孔、撕裂等较为严重并发症。结论钬激光碎石是治疗输尿管结石是一种安全、有效的腔道泌尿外科碎石方法。     

输尿管结石ESWL失败改腔内钬激光碎石术的疗效观察

目的 探讨输尿管结石ESWL失败后采用腔内钬激光碎石术的临床疗效。方法 自2001年10月至2002年8月，对28例输尿管结石(ESWL失败)行输尿管镜下钬激光碎石术。结果 26例经输尿管镜下钬激光碎石术治愈，治愈率92．8％(26／28)；1例结石上移，辅以ESWL治愈；1例因输尿管纤维性扭曲改开放手术。结论 输尿管镜下钬激光碎石术安全、有效、方便，可以作为输尿管结石的首选治疗。     

输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的比较

目的比较输尿管镜下气压弹道碎石术与钬激光碎石术治疗输尿管结石的疗效和安全性。方法总结应用输尿管镜技术治疗326例输尿管结石患者的临床资料，其中气压弹道碎石术176例，钬激光碎石术150例。结杲钬激光碎石术碎石率为96．6％，高于气压弹道碎石术的89．8％（P〈0．01）；钬激光碎石术平均排净时间为10d，短于气压弹道碎石术的21d（P〈0．01）；钬激光碎石组有11例发生血尿，气压弹道碎石有54例发生血尿。结论钬激光碎石术的有效率和安全性优于气压弹道碎石术。钬激光碎石是治疗输尿管结石的一种安全、高效的方法。     

钬激光结合输尿管镜治疗泌尿系结石

目的:探讨钬激光结合输尿管镜腔内治疗泌尿系结石的安全性、有效性。方法:采用钬激光联合输尿管镜治疗泌尿系结石380例。结果:单次手术结石粉碎率达90.8%(345/380),其中肾结石成功率为81.8%(54/66),输尿管上段结石单次碎石成功率为93.1%(284/305),中、下段结石为97.9%(91/93),膀胱结石及尿道结石为100%(9/9)。结论:钬激光联合输尿管镜碎石术治疗泌尿系结石安全、有效,手术技巧容易掌握;尤其适用于结石合并输尿管狭窄、结石合并息肉形成或结石嵌顿包裹,以及体外冲击波碎石失败的患者。     

输尿管镜联合钬激光治疗输尿管上段结石:附205例报告

目的 探讨输尿管镜联合钬激光治疗输尿管上段结石的效果和安全性.方法 回顾性分析205例输尿管上段结石患者行输尿管硬镜钬激光碎石治疗的临床资料,其中男91例,女114例,结石位于单侧188例,双侧17例,炎性息肉引起输尿管腔明显狭窄者12例.结石长径0.8～1.4 cm.结果 192例一次性碎石成功,单次碎石成功率为93.7%(192/205).9例有较大结石碎片(4～6 mm)残留于肾或输尿管内,4例在碎石过程中结石冲入肾内,其中1例较大结石(1.4 cm)移位至肾盂后改行PCNL,其余3例留置双J管改行ESWL,均治愈.19例合并炎性息肉同期行激光烧灼.手术时间15~90min,平均30 min.住院时间2~9 d,平均3.5 d.198例患者在门诊获得随访,随访时间3～24个月,平均6个月,结石均排尽.结论 输尿管镜联合钬激光治疗输尿管上段结石的一种比较理想的腔内碎石技术,其碎石成功率高,并发症发生率低,创伤小,患者术后恢复快,而且可同期处理结石合并炎性息肉和狭窄.     

Holmium:YAG laser for urinary stones

OBJECTIVE: To evaluate the results of Holmium:YAG (Ho:YAG) laser lithotripsy in the treatment of urinary stones. MATERIAL AND METHODS: Between 1993 and 1997, 59 patients with 85 urinary stones were treated with the Ho:YAG laser lithotripsy. Retrospective evaluation was done on the 64 procedures available, comprising 53 ureteric, 8 bladder, and 2 renal calculi, and one stone in a ureterocele. RESULTS: The Ho:YAG laser fragmented all types of calculi. Of 38 patients, 29 (76%) with ureteric stones were stone-free and 7 (18%) had stone fragments smaller than 2 mm left 1-3 months after the lithotripsy, resulting in a total clinical success rate of 95%. The procedure caused four ureteric perforations. One ureteric stricture, after repeated treatments for a Steinstrasse formation, led to nephrectomy. CONCLUSIONS: The Ho:YAG laser was reliable and effective for most of the urinary stones. The largest stones in any location, and stones of hard composition, however, were treated with combined disintegration methods. Four minor ureteric perforations and one ureteric stricture were related to laser use.     

Staging lymphadenectomy in patients with localized high risk prostate cancer: comparison of the laparoendoscopic single site (LESS) technique with conventional multiport laparoscopy

Background

Laser lithotripsy is an established endourological modality. Ho:YAG laser have broadened the indications for ureteroscopic stone managements to include larger stone sizes throughout the whole upper urinary tract. Aim of current work is to assess efficacy and safety of Ho:YAG laser lithotripsy during retrograde ureteroscopic management of ureteral calculi in different locations.

Methods

88 patients were treated with ureteroscopic Ho:YAG laser lithotripsy in our institute. Study endpoint was the number of treatments until the patient was stone-free. Patients were classified according to the location of their stones as Group I (distal ureteric stones, 51 patients) and group II (proximal ureteral stones, 37). Group I patients have larger stones as Group II (10.70 mm vs. 8.24 mm, respectively, P = 0.020).

Results

Overall stone free rate for both groups was 95.8%. The mean number of procedures for proximal calculi was 1.1 ± 0.1 (1–3) and for distal calculi was 1.0 ± 0.0. The initial treatment was more successful in patients with distal ureteral calculi (100% vs. 82.40%, respectively, P = 0.008). No significant difference in the stone free rate was noticed after the second laser procedure for stones smaller versus larger than 10 mm (100% versus 94.1%, P = 0.13). Overall complication rate was 7.9% (Clavien II und IIIb). Overall and grade-adjusted complication rates were not dependant on the stone location. No laser induced complications were noticed.

Conclusions

The use of the Ho:YAG laser appears to be an adequate tool to disintegrate ureteral calculi independent of primary location. Combination of the semirigid and flexible ureteroscopes as well as the appropriate endourologic tools could likely improve the stone clearance rates for proximal calculi regardless of stone-size.

     

Endoscopic lithotripsy with the holmium:YAG laser

BACKGROUND AND OBJECTIVE: The holmium:YAG (Ho:YAG) laser can be used not only for soft tissue but also for hard tissue such as urinary calculi. The objective of this study was to assess the usefulness of the Ho:YAG laser for endoscopic lithotripsy in patients with urinary tract stone. STUDY DESIGN/MATERIASL AND METHODS: Of 102 procedures performed among 96 patients, 88 were transurethral ureterolithotripsy (TUL), seven were percutaneous nephrolithotripsy, and seven were transurethral cystolithotripsy. Six patients had bilateral stones. The fragments were reduced as much as possible with the Ho:YAG laser. RESULTS: The efficacy rate of the 102 lithotripsy procedures was 93%. With respect to the effect of TUL, the efficacy rates of 40 procedures for the proximal ureter, 18 procedures for the midureter, and 30 procedures for the distal ureter were 85%, 94%, and 100%, respectively. CONCLUSION: The Ho:YAG laser produced a sufficiently strong lithotripsy force on all stones. The results of this study indicate that lithotripsy of urinary tract stones with the Ho:YAG laser can achieve a clinical outcome equivalent to or exceeding that of pulsed dye laser lithotripsy. The Ho:YAG laser is a multipurpose laser and thus is a cost effective and very useful means for endoscopic lithotripsy of urinary tract stones.     

输尿管镜钬激光碎石术中并发输尿管穿孔原因及对策

目的探讨输尿管镜钬激光治疗输尿管结石并发输尿管穿孔的原因及防治方法。方法回顾性分析2004年8月至2006年12月经尿道输尿管镜钬激光碎石术268例中25例并发输尿管穿孔的临床资料。男14例，女11例；结石单发者21例，多发者4例；上段结石18例，下段结石7例；结石直径1．2～3．2em，平均（1．8±0．5）cm，25例均合并输尿管息肉及中、重度肾盂积水。术后常规放置双J管4—8周。结果25例输尿管镜手术时间15～70min，平均（40．4±18．3）min。11例一次性碎石成功，6例术中改开放取石治疗，8例结石上移至肾盂内，1周后予以体外冲击波碎石治疗。结论输尿管结石合并息肉是输尿管镜钬激光碎石致输尿管穿孔的主要原因之一，术中轻巧操作是预防出现输尿管穿孔的关键，早期及时开放手术可以避免严重并发症的发生。     

上段输尿管结石的现代微创手术治疗

目的评价各种微创手术方法治疗上段输尿管结石的价值。方法对我院收治的78例上段输尿管结石患者的治疗方法进行回顾性分析。其中经输尿管镜下气压弹道碎石24例,输尿管镜钬激光碎石16例,微创经皮肾输尿管镜取石(mPCNL)27例,后腹腔镜取石3例,开放手术8例。结果输尿管镜气压弹道碎石18例碎石成功,4例因较大残石行ESWL,1例因黏膜出血视野模糊终止手术,1例输尿管部分断裂改开放手术;钬激光组16例均碎石成功;逆行输尿管镜共有2例输尿管穿孔,均成功放置D-J管,2例因输尿管过度迂曲成“盲端”,3例因结石以下输尿管僵硬狭窄无法进镜改开放手术;mPCNL组27例全部取石成功,无严重并发症;后腹腔镜组3例均取石成功,无漏尿发生。结论输尿管镜下碎石是治疗上段输尿管结石的有效手段,钬激光碎石优于气压弹道碎石,可明显提高碎石效率;mPCNL是一种安全、非常有效的治疗方法,对于结石较大、较硬以及靠近肾盂的结石尤为适宜;经腹腔镜取石与上述方法相比,耗时长、创伤大,但对曾行微创取石失败的患者是一个理想的选择。     

A comparison of holmium:YAG laser with Lithoclast lithotripsy in ureteral calculi fragmentation

PURPOSE: Among various intracorporeal lithotriptors, Lithoclast (EMS, Switzerland) has become the widely used tool for the treatment of urinary stones. Recently, the holmium:YAG laser has been used with a wide range of potential urological applications, including intracorporeal lithotripsy of urinary calculi. The purpose of the present study is to compare Lithoclast with holmium:YAG laser lithotripsy in ureteral calculi fragmentation. METHODS: Out of 51 patients with ureteral calculi, 26 underwent Lithoclast lithotripsy and 25 holmium:YAG lithotripsy using a 8/9.8F rigid ureteroscope. There were no changes to the ureteroscopes, video monitors, baskets or irrigation devices during the study period. RESULTS: There were no differences in patient age, sex, stone size and location of stones between these groups. The immediate stone-free rates were 96.0% in the holmium:YAG group and 73.1% in the Lithoclast group (P < 0.05). The 3-month stone-free rates were 96.0% and 84.6%, respectively (P = 0.350). The mean operation time and mean period of postoperative hospitalization in the holmium:YAG group (49.8 min and 1.0 days, respectively) were shorter than those of the Lithoclast counterpart (76.9 min and 2.5 days, respectively). Post-treatment complications, such as ureteral perforation, were encountered in only two patients who underwent Lithoclast. CONCLUSIONS: Holmium:YAG lithotripsy was associated with shorter operation time and postoperative hospitalization period. These data also suggest that holmium:YAG lithotripsy was safe and more effective than Lithoclast lithotripsy in the aspect of immediate stone free rate. We believe that holmium:YAG laser is an excellent treatment modality for managing ureteral calculi.     

腔内钬激光治疗输尿管结石并发息肉115例分析

目的：探讨钬激光治疗输尿管结石并发息肉的临床疗效及并发症的预防。方法：回顾性分析2007年5月-2008年12月我科行输尿管镜下钬激光治疗输尿管结石并发息肉115例I临床资料。结果：一次性息肉切除并碎石成功98例;例息肉切除时结石上移至肾盂内12,术后1周行体外冲击波碎石治疗,效果良好;5例输尿管上段呈N型折叠成角,息肉烧灼时致输尿管穿孔而改开放手术治疗。平均手术时间46rain（16-80min）,平均住院时间7天（4～11天）。95例随访6个月～1年,复查静脉肾盂造影显示输尿管通畅,未见明显结石残留。结论：腔内钬激光同时治疗输尿管息肉并发结石安全、有效、确切,规范、轻柔、熟练的操作技巧是预防和减少并发症发生的关键。