输尿管镜钬激光治疗输尿管下段石街15例临床分析

目的 探讨输尿管镜下钬激光碎石取石术治疗体外冲击碎石(ESWL)后输尿管下段石街的疗效及可行性.方法 本组15例均为ESWL术后输尿管下段石街形成并梗阻患者,采用输尿管镜下钬激光碎石取石术并留置双J管内引流.结果 12例输尿管石街被清除,3例部分上端结石移位至肾孟,2例再次行ESWL后治愈,1例2周后复查未见明显残余结...     

输尿管镜下钬激光治疗ESWL后输尿管石街的疗效观察

目的：评价输尿管镜下钬激光治疗ESWL术后输尿管石街的疗效。方法：对ESWL术后输尿管石街形成的21例患者行输尿管镜下钬激光碎石治疗。结果：21例患者中,19例碎石成功,1个月后复查输尿管石街排出,成功率为90．5％;1例上段输尿管石街部分结石移位至肾盂而再次行ESWL治疗;1例因输尿管上段扭曲和狭窄而改行开放手术。结论：输尿管镜下钬激光治疗ESWL术后输尿管石街成功率高,碎石时间短,安全可靠,操作简单,值得在临床上推广应用。     

输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石112例

【摘要】〓目的〓探讨输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石的临床效果及安全性。 方法〓应用输尿管硬镜下钬激光碎石取石术治疗112例输尿管上段结石患者。男63例,女49例,年龄18~87岁(46.7±13.6岁),左侧61例,右侧46例,双侧5例。结石长径0.7~2.2 cm(1.2±0.5 cm)。26例合并输尿管息肉,31例曾行体外冲击波碎石术,所有患侧肾脏均合并不同程度肾积水。 结果〓手术成功率88.4%(99/112),手术时间15~80 min(33.6±16.8 min),术后住院天数3~14天(4.7±2.1天)。所有患者均无严重肉眼血尿、输尿管穿孔、粘膜撕裂、输尿管镜石街形成等并发症。3例患者出现畏寒、高热,其中1例发展为尿源性脓毒血症,予以积极抗感染治疗后,症状逐渐缓解。结论〓输尿管硬镜下钬激光碎石取石术治疗输尿管上段结石是安全,有效的治疗方法。     

输尿管软镜下钬激光碎石治疗经皮肾镜取石术后残留结石

目的探讨输尿管软镜下钬激光治疗经皮。肾镜取石术后残留结石的疗效。方法收集经皮肾镜取石术后残留结石患者43例,残石直径6—30mm。经留置输尿管扩张鞘置入Wolf输尿管软镜（6／8．8F,上下弯180／270°）抵达肾盂,以200μm光纤,〈30W钬激光粉碎残留结石,较大碎石用取石篮取出。结果43例患者均找到残余结石,结石寻及率100％（43／43）,42例患者成功粉碎结石,碎石成功率97．7％（42／43）。8例联合经皮肾镜碎石取石,无严重并发症发生。结论输尿管软镜钬激光碎石治疗经皮肾镜取石术后残留结石安全、有效。     

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。     

输尿管镜下国产钬激光碎石取石术治疗输尿管结石（附124例报告）

目的总结输尿管镜下国产钬激光碎石取石术治疗输尿管结石的临床经验。方法应用Wolf8．0／9．8F硬性输尿管镜,国产30W钬激光碎石机治疗124例输尿管结石患者,输尿管中下段结石87咧,上段结石37例。结果124例输尿管结石,108例1次碎石成功,16例失败,单次碎石成功率87％（108／124）：其中,中下段结石单次碎石成功率为95％（83／87）,上段结石67．5％（25／37）,术中无输尿管穿孔、撕裂等并发症。结论输尿管镜下国产钬激光碎石取石术治疗输尿管结石是安全、有效的方法,特别适合在中小医院使用。     

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。     

输尿管镜下钬激光碎石治疗输尿管膀胱壁段结石

目的：探讨不切开输尿管口,直接输尿管镜下钬激光碎石治疗输尿管膀胱壁段结石的手术技巧。方法：选取输尿管膀胱壁段结石患者32例,根据结石的分类,不切开输尿管口,采取盲法结合直视下输尿管镜钬激光碎石,术后留置双J管2～4周,3～6个月后复查B超、CT或者IVU。结果：32例患者均成功粉碎结石,其中10例发生输尿管黏膜轻微撕脱,1例发生输尿管黏膜下假道。留置双J管后随访,复查正常。结论：不切开输尿管口,采取盲法结合直视下输尿管镜钬激光碎石治疗输尿管膀胱壁段结石是一种安全有效的微创治疗。     

输尿管镜钬激光碎石治疗嵌顿输尿管结石临床分析

目的：探讨输尿管镜钬激光碎石治疗嵌顿输尿管结石的有效性和安全性。方法：分析2005年10月～2008年5月输尿管镜下钬激光碎石治疗嵌顿输尿管结石268例患者临床资料，对碎石率、排石率和并发症等进行统计分析。结果：共行272例次输尿管镜钬激光碎石，一次碎石成功率为92．6％（252／272），输尿管上段与中、下段结石一次碎石成功率分别为84．6％（66／78）、95．9％（186／194）；平均手术时间35min。平均碎石时间16min；结石移位改行ESWL8例，结石位置较高改行微创经皮肾镜取石9例，改开放手术取石3例；碎石过程中黏膜撕裂4例、黏膜下假道形成6例，输尿管穿孔4例；18例术后发热（体温〉38．5℃，持续2天以上），5例出现体温〉39℃，其中1例发生感染性休克前兆；术后住院2～6天；2周～1个月拔除双J管，复查B超、KUB、IVP，结石排净率97．1％（264／272），肾盂积水由（2．6±0．6）cm降至（1．4±0．4）cm（P〈0．01）；随访3～24个月，3例发现输尿管狭窄。结论：输尿管镜钬激光碎石治疗嵌顿输尿管结石安全、有效，尤其适用于中、下段嵌顿输尿管结石。     

输尿管软镜手术中放置输尿管通道鞘引起输尿管壁损伤的研究分析

目的 评估输尿管软镜手术中放置输尿管通道鞘引起的输尿管壁损伤情况,并了解术前留置双J管能否减轻放置输尿管通道鞘引起的输尿管壁损伤.方法 112例进行输尿管软镜下碎石术的患者被随机分为两组,A组先留置双J管,2～3周后再进行输尿管软镜下碎石术,B组则术前不留置双J管而直接手术,比较两组患者输尿管壁损伤情况.结果 在A组患者中,出现低级别(0级+1级)的放置输尿管通道鞘引起的输尿管壁损伤共有53例,高级别(2级+3级+4级)的仅2例,而在B组患者中,出现低级别的放置输尿管通道鞘引起的输尿管壁损伤共有33例,高级别的共有24例,两组间比较有统计学差异(P＜0.05).结论 输尿管软镜术中放置输尿管通道鞘可引起不同程度的输尿管壁损伤,术前留置双J管可明显降低高级别的放置输尿管通道鞘引起的输尿管壁损伤的发生几率.     

输尿管镜下钬激光碎石在小儿输尿管结石中的应用

目的 探讨输尿管镜下钬激光碎石治疗小儿输尿管结石的安全性和效果.方法 患儿7例,男5例,女2例,年龄1.5～13岁,平均6.5岁.输尿管上段结石1例,中下段6例.左侧4例,右侧3例.结石直径0.5～0.9 cm.均伴中、轻度肾积水.临床主要表现为患侧腰腹疼痛和/或血尿,无泌尿系畸形、感染和血、尿生化、电解质异常.结果 全部手术一次成功,无并发症,2例并发输尿管息肉同时处理.手术时间6～15 min,平均12min.术后1～3天拔除导尿管,2～5天后出院,2周拔除双"J"管.术后复查结石排净6例,另1例再过2周排净.随访1～12个月无结石复发,肾积水均恢复正常.结论 输尿管镜联合钬激光碎石术治疗小儿输尿管结石安全有效,但还需要积累更多的病例,进行更长时间的随访.     

Holmium: YAG laser endoureterotomy for treatment of ureteral stricture

Objectives

Endourologic techniques ranging from balloon dilation to endoincision with electrocautery, cold knife, and lasers have been increasingly used in recent years for the treatment of ureteral strictures. While the long-term results may not be as reliable or as durable as traditional reconstructive surgical techniques, they can be accomplished with much less morbidity. Recently, the holmium:yttrium-aluminum-garnet (YAG) laser, which possesses both cutting and coagulating properties, has been demonstrated to have many applications in urology. We report our experience with this laser in the endoscopic treatment of ureteral strictures.

Methods

We reviewed the charts and follow-up history of 22 patients in whom the holmium:YAG laser was used to treat ureteral strictures from a variety of causes and including those in ureteroenteric anastomoses. Strictures were either approached in a retrograde fashion with a 6.9F ureteroscope or antegrade with flexible instruments in the cases involving ureteroenteric strictures. The only energy source employed was the laser, followed by balloon dilation. Indwelling stents were left in place for at least 4 weeks postoperatively and follow-up was obtained with radiographic imaging.

Results

A minimum 9-month follow-up was available for 18 patients. There were 5 patients who had developed recurrent strictures and were therefore considered treatment failures. Each of these patients failed in less than 3 months and all had either lengthy or complex strictures noted at the time of surgery. One patient was lost to follow-up and three recent patients have follow-up of 3 to 6 months showing no evidence of recurrent stricture formation. Overall, 16 of 21 (76%) patients are clinically well with no evidence of stricture recurrence.

Conclusions

Endoureterotomy for ureteral stricture disease is a minimally invasive, less morbid, but ultimately less successful, alternative to open surgical reconstruction. Stricture length and etiology remain the most important determinants of success. The holmium:YAG laser, with its ability to precisely cut tissue and provide hemostasis and its multiuse potential and compatibility with small rigid and flexible endoscopic instruments, is an ideal tool for performing endoureterotomy.     

输尿管镜致输尿管严重损伤的处理

目的探讨输尿管镜致输尿管严重损伤的处理方法。方法回顾性分析我院2 876例输尿管镜诊疗过程中15例输尿管严重损伤的临床资料。15例中,输尿管断裂4例,均行输尿管吻合术;输尿管全层撕脱4例,其中1例行肾下移输尿管膀胱瓣吻合,2例行回肠代输尿管术,1例行肾切除术;输尿管黏膜袖套样剥离7例,其中4例内置双J管引流,1例行输尿管膀胱瓣吻合,2例行回肠代输尿管术。结果所有患者均经随访3个月～3年,1例出现输尿管末端狭窄闭锁,行输尿管膀胱再植术后治愈,1例因反复肾感染行肾切除外,余13例均无异常。结论输尿管镜手术致输尿管严重损伤时,及时发现损伤并按损伤类型不同,分别采用输尿管吻合、输尿管膀胱吻合、回肠代输尿管等方法处理,疗效满意,预后好。     

钬激光治疗输尿管结石51例

目的 总结输尿管镜下钬激光治疗输尿管结石的经验和体会。方法 2002-03～06采用输尿管镜下钬激光碎石术治疗输尿管结石51例(59侧)。结果 侧输尿管结石被粉碎55例,成功率93.2％。碎石后肾绞痛7例,无感染和输尿管损伤发生。手术后平均住院3.5d。结论 钬激光碎石术是治疗输尿管结石一种安全、有效的方法。     

输尿管镜下钬激光术治疗并发息肉的输尿管结石疗效观察

目的:探讨输尿管镜下钬激光术治疗并发息肉的输尿管结石的有效性、安全性及相关技巧.方法:采用硬性输尿管镜下钬激光术治疗并发息肉的输尿管结石患者60例.输尿管结石大小0.5 cm×0.5 cm～1.5cm×2.2 cm,在结石周围或下方均并发息肉.结果:手术时间10 min～1 h,平均21 min.60例患者息肉均一次治疗成功;除2例上段结石被冲入肾盂外,其余58例均单次原位碎石成功.中、下段结石术中破碎率及4周后碎石排净率均为100%.术中未发生输尿管黏膜撕脱、输尿管穿孔、输尿管黏膜隧道等严重并发症.术后仅有轻微血尿,无低热、肾区疼痛等不适.结论:输尿管镜下钬激光术是治疗并发息肉的输尿管结石有效而安全的方法.     

Holmium:yttrium-aluminum-garnet laser endoureterotomy for the treatment of transplant kidney ureteral strictures

BACKGROUND: The management of ureteral strictures in transplanted kidney is challenging. Open surgical treatment is effective but entails significant convalescence. Holmium:yttrium-aluminum-garnet (Ho:YAG) laser endoureterotomy is useful for other types of ureteral obstruction, and we aimed to assess its long-term success for strictures of transplant kidney ureters. METHODS: We reviewed the course of 12 kidney transplant patients managed with Ho:YAG laser endoureterotomy and/or percutaneous ureteroscopic balloon dilatation for ureterovesical anastomotic strictures or ureteropelvic junction obstruction. Success was defined as stable serum creatinine and no hydronephrosis on follow-up. RESULTS: Of the patients, nine had ureterovesical anastomotic strictures. Of the six treated with balloon dilatation and Ho:YAG laser endoureterotomy, the success rate was 67% (58 months mean follow-up). Both strictures with failure were longer than 10 mm. Of the three patients treated with balloon dilatation only, there was success in only one (14 months follow-up) and both strictures with failure were shorter than 10 mm. There were three patients treated for ureteropelvic junction obstruction, one with balloon dilatation and two with balloon dilatation plus Ho:YAG laser endoureterotomy, all successfully (57 months mean follow-up). Overall, of the eight strictures 10 mm or shorter, there was success rate in six (75%), with 52 months mean follow-up, including five of five (100%) treated with laser endoureterotomy and one of three (33%) treated with only balloon dilation. CONCLUSIONS: Our results suggest that Ho:YAG laser endoureterotomy should be a first line treatment for ureteral strictures of length 10 mm or shorter in kidney transplant patients.     

腔内钬激光碎石术治疗输尿管上段结石的体会(附121例报告)

目的探讨腔内钬激光碎石术治疗上段输尿管结石的技巧与方法。方法回顾性分析121例应用硬性输尿管肾镜和钬激光碎石术治疗上段输尿管结石患者资料。结果单次碎石成功率为95%(115/121)。术后随访2周~6个月,除6例失败者外,结石排净率98%(113/115),I VU示肾盂积水由术前(3.5±0.8)cm降至(1.5±0.4)cm(P<0.01),无输尿管狭窄发生。结论腔内钬激光碎石术治疗上段输尿管结石,尤其是结石直径>1cm同时合并输尿管息肉及狭窄者有明显优势,熟练掌握输尿管镜的技巧和方法是保证手术成功的重要因素之一。