输尿管镜下双频激光碎石术治疗输尿管结石268例报告

目的探讨输尿管镜下激光碎石术治疗输尿管结石的疗效。方法2004年4月-2006年8月,我院采用德国Storz半硬输尿管镜（F6.9或者F8/9.8）和德国W om公司U100双频双脉冲激光碎石机治疗输尿管结石268例。结果单次治疗成功率为92.9%（249/268）。手术时间15-95 min,平均30 min。术后除出现不同程度血尿外（术后2-3 d消失）,无严重并发症。术后住院时间2-6 d,平均3.5 d。229例随防3-9个月,平均6.2月,KUB联合静脉肾盂造影（intravenous pyelography,IVP）或者B超检查,无复发及输尿管狭窄发生。结论输尿管镜下双频双脉冲激光碎石术是治疗输尿管结石的理想方法,可作为输尿管中下段结石首选治疗。     

钬激光碎石术与双频双脉冲激光碎石术治疗输尿管结石的比较

目的:比较经输尿管镜钬激光碎石术和双频双脉冲激光碎石术治疗输尿管结石的疗效与安全性。方法:对输尿管镜技术治疗101例输尿管结石患者,以钬激光碎石术治疗46例,双频双脉冲激光碎石术治疗55例,进行疗效比较。结果:钬激光碎石术结石一次粉碎率为91.3%,双频双脉冲激光碎石术结石一次粉碎率为87.3%;前者平均碎石时间(28.9min)短于后者(37.9min)(P<0.01);前者平均结石排净时间为16.5d,短于后者的26.3d(P<0.01);前者2例发生穿孔,后者无穿孔发生。结论:钬激光碎石术及双频双脉冲碎石术均为有效的碎石方法;在平均碎石时间、结石排净时间方面钬激光碎石术具有优势;双频双脉冲激光碎石术在安全性方面具有优势。     

输尿管镜下钬激光碎石术治疗132例输尿管结石

目的探讨输尿管镜下钬激光碎石术治疗输尿管结石的临床疗效。方法回顾分析2005年5月-2006年5月采用输尿管镜下钬激光碎石术治疗输尿管结石132例的临床资料。结果单次碎石成功率为95．5％（126／132）。术后随访4～8周，结石排净率为98．4％（124／126）。平均手术时间和平均术后住院天数分别为35min、3d。结论输尿管镜下钬激光碎石术是输尿管结石安全有效的治疗方法；对于复杂性或双侧的输尿管结石，本法可作为首选。     

输尿管镜钬激光碎石术治疗输尿管结石

目的：探讨输尿管镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法：回顾性分析216例应用经输尿管镜钬激光碎石术治疗的输尿管结石患者资料。男133例,女83例;年龄20～68岁,平均49岁。上段结石48例,中段58例,下段110例。结石直径0．7～2．6cm,平均1．4cm。结果：单次碎石成功率为98．1％（212／216）,其中上段结石单次碎石成功率为91．6％（44／48）,中、下段为100％（168／168）。平均手术时间29min,212例术后平均住院3．5天。术后随访2周～3个月,结石排净率99％（210／212）。结论：输尿管镜钬激光碎石术治疗输尿管结石高效、安全,可作为输尿管结石特别是中下段结石首选的治疗方法。     

输尿管肾镜钬激光碎石术治疗输尿管结石

目的　探讨输尿管肾镜钬激光碎石术治疗输尿管结石的有效性和安全性。　方法　回顾性分析 186例应用半硬性输尿管肾镜和钬激光碎石术治疗的输尿管结石患者资料。男 12 3例 ,女 6 3例 ;平均年龄 5 1岁。上段结石 5 1例 ,中段 6 4例 ,下段 71例。结石直径 0 .6～ 2 .5cm ,平均 1.3cm。　结果　单次碎石成功率为 96 % (179/ 186 ) ,其中上段结石单次碎石成功率为 90 % (46 / 5 1) ,中、下段为99 % (133/ 135 )。平均手术时间 2 8min ,术中无输尿管穿孔等并发症发生。 179例术后平均住院 1.2d。术后随访 2周～ 3个月 ,结石排净率 99% (177/ 179) ,肾盂积水由术前 (3.6± 0 .7)cm降至 (1.5± 0 .4 )cm(P <0 .0 1) ,无输尿管狭窄发生。　结论　输尿管肾镜钬激光碎石术治疗输尿管结石高效、安全 ,可作为输尿管结石特别是中下段结石首选的治疗方法。     

经输尿管镜钬激光碎石治疗输尿管结石

目的探讨经输尿管镜钬激光碎石治疗输尿管结石的临床效果. 方法 90例输尿管结石,经尿道、膀胱置入10°输尿管镜抵达结石处,将光纤头直抵结石,设置工作能量0.8～1.5 J,频率8～10 Hz,采用连续脉冲方式粉碎结石. 结果3例进镜失败(输尿管镜无法到达结石部位)改开放手术,1例输尿管穿孔改开放手术;86例碎石成功,单次钬激光碎石成功率为95.6%(86/90).手术时间30～80 min,平均55 min.术后住院1～5 d,平均2.5 d.86例随访1～3个月,69例病程＜6个月、肾积水＜4 cm,肾积水完全消失;17例病程＞6个月、肾积水＞4 cm,术后患肾均有不同程度积水,但较术前明显改善. 结论经输尿管镜钬激光碎石治疗输尿管结石效果理想,创伤小,并发症少,可作为输尿管中、下段结石的首选治疗方法.     

经输尿管镜钬激光碎石治疗输尿管结石

目的探讨输尿管镜钬激光碎石术治疗输尿管结石的有效性和安全性。方法回顾性分析59例采用输尿管镜钬激光碎石治疗输尿管结石的患者资料。男37例，女22例，平均54．3岁。结石位于输尿管上段16例，中段13例，下段30例。结石直径0．7—1．8cm，平均1．05cm。结果单次碎石成功率为90％（53／59），其中上段结石单次碎石成功率为69％（11／16），中、下段为98％（42／43）。平均手术时间32．2min，术中无输尿管穿孔等并发症发生，平均住院2．9天。57例随访1-3个月，结石排净率98％（56／57），无输尿管狭窄发生。结论输尿管镜钬激光碎石治疗输尿管结石创伤少，成功率高，可作为输尿管结石特别是中、下段结石首选的治疗方法。     

输尿管镜钬激光碎石术治疗输尿管结石效果分析

目的分析输尿管镜钬激光碎石术治疗输尿管结石的效果。方法收集2016-01—2017-03间在中牟县人民医院接受输尿管镜钬激光碎石术治疗的60例输尿管结石患者,对其临床治疗进行回顾性分析。结果本组手术时间为(53.35±7.20) min,住院时间为(5.64±1.31) d。58例(96.67%)患者1次碎石成功;2例由于术中结石进入肾盂,遂置入双J管。1周后行体外冲击波成功碎石。术中发生1例输尿管穿孔,经留置双J管后治愈。术后2例发生泌尿系感染,给予抗感染治疗后痊愈。未发生输尿管狭窄等其他并发症。术后3个月复查,结石排净率为100.00%。结论对输尿管结石患者实施输尿管镜钬激光碎石术治疗,碎石成功率及结石排净率高,并发症少,安全性好。     

输尿管镜下双频双脉冲激光粉碎上段输尿管结石

目的评价U-100双频双脉冲激光经输尿管镜粉碎七段输尿管结石的疗效。方法回顺性分析85例采用U－100双频双脉冲激光碎石器经输球管镜治疗的上段输尿管结石患者的临床资料。结果一次碎石成功率为88．2％（75／85）。平均手术时间35（15～60）min，平均激光工作时间2．8（1～5）min。碎石后平均15（7～28）d结石排净。其中，5例因结6被息肉包裹或其远端输尿管紧闭而直接伸进光纤行盲目碎石，有4例获得成功。10例一次碎石失败的原因为：结石冲入肾盂6例，插镜失败2例，碎石不完全2例。无一例发生输尿管穿孔、感染等行发症。结论U－100双频双脉冲激光能迅速高效地粉碎上段输尿管结石，对正常输尿管壁无损伤。     

输尿管镜下U100激光碎石术治疗输尿管结石252例分析

2005年5月-2007年11月，本院应用输尿管镜下U100激光碎石治疗252例输尿管结石，效果良好，现报告如下。 1 资料与方法 1．1临床资料本组252例，男性148例，女性104例；年龄19～70岁，平均43岁。患者均为输尿管结石，其中右侧167例，左侧85例；上段46例，中段92例，下段114例；双侧输尿管结石5例（均出现不同程度的肾功能不全）。结石直径0．8～1．7cm，平均1．0cm。     

经输尿管镜液电冲击波及Nd：YAG激光治疗输尿管结石并息肉：附26例报告

采用经输尿管镜液电冲击波及Ｎｄ：ＹＡＧ激光治疗输尿管结石并息肉２６例，其中输尿管上段结石５例，中段６例，下段１５例。结果２２例治疗成功，成功率为８４．６％。认为经输尿管镜液电冲击波及Ｎｄ：ＹＡＧ激光治疗输尿管结石并息肉是有效方法。文中对治疗的操作方法、注意事项及术后并发症作了详细介绍。     

输尿管软镜钬激光碎石术治疗输尿管上段结石

目的 总结输尿管软镜结合钬激光治疗输尿管上段结石的疗效及并发症,探讨手术技巧.方法 38 例输尿管上段结石患者接受输尿管软镜钬激光碎石治疗,先使用8/9.8 F 输尿管硬镜探查患侧输尿管,置入导丝后留置输尿管软镜鞘,引入输尿管软镜,钬激光碎石,并使用套石篮套取出较大的结石碎屑.结果 35 例患者一期顺利碎石,3 例因输尿管狭窄难以置入输尿管软镜鞘,留置输尿管内支架2 周后再次手术成功.手术时间31~56 min,平均42 min.术后7 例患者发热,无其他严重并发症.术后1 个月拔除内支架,2 周后复查KUB,结石清除率92.1%.结论 输尿管软镜结合钬激光是处理输尿管上段结石的有效手段,即便输尿管结石进入肾内,也可一期处理,避免了额外的体外碎石操作.     

The pulsed dye laser versus the Q-switched Nd:YAG laser in laser-induced shock-wave lithotripsy

To date, there are two fairly well-established alternatives for laser-induced shock-wave lithotripsy in clinical practice. The Q-switched Nd:YAG laser is distinguished by the high-stone selectivity of its coupler systems. The necessity of a coupler system and its fairly small conversion rate of light energy into mechanical energy present serious drawbacks. Furthermore, the minimal outer diameter of the transmission system is 1.8 mm. The pulsed-dye laser can be used with a highly flexible and uncomplicated 200-micron fiber. However, the laser system itself is more complicated than the Q-switched Nd:YAG laser and requires a great deal of maintenance. Biological evaluation of damage caused by direct irradiation shows that both laser systems produce minor damage of different degrees. YAG laser lithotripsy with the optomechanical coupler was assessed in 31 patients with ureteral calculi. The instability and limited effectiveness of the fiber application system necessitated auxiliary lithotripsy methods in 14 cases. Dye-laser lithotripsy is currently being tested in clinical application. Further development, such as systems for blind application or electronic feedback mechanisms to limit adverse tissue effects, have yet to be optimized. Nevertheless, laser-induced shock-wave lithotripsy has the potential to become a standard procedure in the endourologic management of stone disease.     

The Nd:YAG laser in neurological surgery

The Nd:YAG laser has been applied in microneuro-surgery and has been found to be quite effective in removing had and hemorrhagic tumors such as meningiomas, tumors of the deep skull base, or tumors deep in the ventricle. Another indication for the use of the Nd:YAG laser is to open the thick sellar floor in transsphenoidal operations.     

Clinical application of the Nd:YAG laser endoscopy

We report here our clinical experiences with Nd:YAG laser therapy, and evaluate the results of this treatment. From July 1980 to December 1981, we carried out endoscopic laser treatment for 31 patients with 33 lesions. Bleeding gastric ulcers except stomal ulcers were treated successfully. For mucosal lesions of the stomach, Nd:YAG laser irradiation was effective in extirpating them. In advanced gastric cancers, symptoms of cardiac stenosis could be relieved in 80% of the cases. Endoscopic laser therapy was also effective in 80% of postoperative stenosis in the gastrointestinal tract. It is concluded that endoscopic irradiation with the Nd:YAG laser is useful for hemostasis and also for the treatment of malignant tumors and stenosis of the gastrointestinal tract.     

双频双脉冲激光碎石联合坦索罗辛治疗输尿管结石221例分析

目的：探讨双频双脉冲U-100掺钕钇铝石榴石（Nd：YAG）激光输尿管硬镜技术联合药物排石治疗输尿管结石的临床效果。方法：采用双频双脉冲U100Nd：YAG激光碎石器及输尿管硬镜对221例输尿管结石（直径10～25mm）患者进行碎石治疗,配合术后口服坦索罗辛0．4mg／d,共28天。结果：结石碎石率分别为：上段结石76．2％,中段90．2％,下段97．9％;19例未成功,其中11例上段结石上移至肾脏,2例上段输尿管扭曲,6例输尿管狭窄置镜失畋。术后1个月结石排尽率为91．4％（同期单纯ESWL为75．6％,单纯输尿管镜碎石为82．3％,P〈O．05）。结论：U100激光结合口服坦索罗辛治疗输尿管结石（直径10～25mm）安全、有效,可明显提高结石清除率。     

Histological evaluations following 1,064-nm Nd:YAG laser resurfacing

BACKGROUND AND OBJECTIVES: The long pulse 1,064-nm Nd:YAG laser is used clinically to decrease rhytid formation. The dermal level at which this change occurs has not been established. This study attempts to answer these questions using a porcine skin model. STUDY DESIGN/MATERIALS AND METHODS: Non-randomized prospective experimental trial involving the domestic piglet treated serially with the long pulse 1,064-nm Nd:YAG laser. RESULTS: Collagen formation occurred at the level of the reticular dermis. After one laser treatment, a significant level of collagen formation was induced in the reticular dermis compared to controls. The greatest gain was observed after four laser treatments. Energy levels of 20, 30, 40, and 50 J/cm2 were evaluated. Although not statistically significant, 30 J/cm2 had the greatest effect on collagen formation. However, at 50 J/cm2, marked ablative changes to the epidermis were observed. CONCLUSIONS: The long pulse 1,064-nm Nd:YAG laser induces collagen formation in the reticular dermis in porcine skin.     

The use of the Nd:YAG laser in urology

The use of the neodymium:YAG(Nd:YAG) laser in urology in still in its infancy. To date, the most widely published application of this laser is in the treatment of bladder carcinoma. We have utilized the Nd:YAG laser in 23 treatments for superficial bladder tumors. The laser has both advantages and shortcomings, which are thoroughly addressed. In our hands the laser has been a safe instrument for the treatment of these lesions, although we do not recommend its use for tumors greater than 3 cm. We have treated two patients with invasive disease one week prior to planned cystectomy. In one case, no residual tumor was found at cystectomy, while the second patient had viable tumor only in an untreated area. Two patients were successfully treated with the laser for intractable bladder bleeding, one each with primary and secondary bladder tumor. Seven patients with condylomata acuminata were treated with laser therapy. All had excellent results without complication. One patient with urethral bleeding secondary to trauma was treated without success, while one patient with a urethral hemangioma was well treated with the Nd:YAG laser. Thus the Nd:YAG laser would appear to have a place in the urologic armamentarium, but whether it is cost-effective for widespread use remains to be seen.     

Histologic evaluation of the pulsed Nd:YAG laser for laser lipolysis

BACKGROUND AND OBJECTIVES: Laser lipoplasty with pulsed Nd:YAG laser, widely used in Europe and Latin America, has recently been introduced in Japan and the USA. We report histologic analyses of the effects of the laser on human fat tissue. STUDY DESIGN/MATERIALS AND METHODS: Freshly excised human skin and subcutaneous fat were irradiated with the pulsed Nd:YAG laser (SmartLipo, DEKA, Italy). A 1,064 nm laser at 40 Hz and 150 mJ and 100 microseconds-long pulses were used. Methods of exposure were the same as in the clinical application. In the control group, the specimens were cannulated by the handpiece without irradiation. The tissue was studied by scanning electron microscopy and hematoxylin eosin staining. RESULTS: Scanning electron microscopy after irradiation showed greater destruction of human adipocytes than in the control. Degenerated cell membrane, vaporization, liquefaction, carbonization, and heat-coagulated collagen fibers were observed. CONCLUSIONS: Our study showed that the SmartLipo appeared to be histologically effective for destruction of human fat tissue.     

Preliminary study of the Nd:YAG laser in canine partial nephrectomy

Partial nephrectomy is effective in the treatment of segmental renal disease but hemostasis remains a challenge. In this preliminary investigation the Nd:YAG laser was used alone or as an adjunct to the scalpel in partial nephrectomies to determine if hemostasis could be improved. A technique of 100-W laser transection with occlusion of the renal artery was effective for partial nephrectomy and achieved complete hemostasis. Conditions of patent renal artery flow or renal cooling were associated with a reduction in necrosis depth with 100-W laser partial nephrectomies. All techniques were compatible with survival over the 5-day study period.