组合式输尿管软镜联合钬激光治疗上尿路结石

目的评价组合式输尿管软镜联合钬激光治疗上尿路结石的安全性及临床疗效。 方法收集2015年4月至2017年4月我院采用组合式输尿管软镜治疗433例上尿路结石患者的临床资料。单发性结石178例，多发性结石255例；肾中上盏132例，肾下盏结石97例，输尿管上段及肾盂结石204例。结石直径为0.8～4.0 cm。 结果一次性进镜成功率100%，手术时间30～280 min，术后住院时间1.0～5.0 d。1例结石未寻及，改为体外冲击波碎石。3例光纤无法触及结石，均改为经皮肾镜术。其他429例均实施组合式输尿管软镜术。术后2周复查腹部平片或泌尿系CT平扫，结石排净率84.4%（362/429），二次手术37例，最终结石清除率为89.9%（386/429）。未发生输尿管穿孔、撕脱及大出血等严重并发症。 结论组合式输尿管软镜联合钬激光治疗上尿路结石临床应用安全，疗效理想,可作为输尿管上段结石及肾结石的理想治疗方案，具有很好的临床应用价值。

Modular flexible ureteroscopic lithotripsy with holmium laser for upper urinary calculi

ObjectiveTo evaluate the safety and clinical efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy in the treatment of upper urinary tract calculi. MethodsClinical data of 433 patients diagnosed with the upper urinary tract calculi treated with flexible ureteroscopy in our hospital from April 2015 to April 2017 were collected. Among them, 178 cases were diagnosed with solitary calculi and 255 cases of multiple calculi. The calculi were observed in the middle and upper calyces of kidney of 132 patients, the lower calyces of kidney of 97 cases and the upper ureter and renal pelvis of 204 patients. The diameter of the calculi was ranged from 0.8 to 4.0 cm. ResultsThe success rate of one-time ureteroscope placement was 100%. The operation time was 30-280 min. The length of postoperative hospital stay was 1.0-5.0 d. The calculi were not detected in one patient and then extracorporeal shock wave lithotripsy was adopted. Three cases were treated with percutaneous nephrolithotomy because the optical fiber failed to detect the stones. The remaining 429 patients underwent modular flexible ureteroscopy. At postoperative two weeks, plain abdominal or urinary CT scan demonstrated that the stone removal rate was 84.4% (362/429). Secondary operation was performed in 37 cases. The final stone removal rate was 89.9% (386/429). No severe postoperative complications, such as ureteral perforation, avulsion and massive bleeding, occurred. ConclusionThe modular flexible ureteroscopy combined with holmium laser is safe and effective treatment of the upper urinary tract calculi, which serves as an ideal therapeutic option for the upper urinary tract and renal calculi in clinical practice.