钬激光碎石术治疗泌尿系结石(附1 216例报告)

目的探讨钬激光碎石术治疗泌尿系结石的疗效及其安全性。方法应用输尿管肾镜和膀胱镜联合钬激光碎石术治疗1216例泌尿系结石，其中输尿管结石1006例（上段302例，中段364例，下段340例），膀胱结石210例。结果l例输尿管上段结石因前列腺增生症致置镜困难改体外冲击波碎石（extracorporeal shock wave lithotripsy,ESWL）治疗。l006例输尿管结石单次碎石成功率95．5％（961／1006）），其中上、中、下段结石单次碎石成功率分别为89．4％（270／302）、96．4％（351／364）和100％（340／340），术中发生6例输尿管穿孔。膀胱结石单次碎石成功率为100％（210／210），无出血和膀胱穿孔发生。881例输尿管结石术后随访0．5—40个月，平均18．6月，输尿管上、中、下段结石排净率分别为91．1％（224／246）、98.5％（318／323）、100％（312／312），总结石排净率为96．9％（854／881）；6例发生输尿管狭窄。187例膀胱结石术后随访0.5～31个月，平均12．4月，结石排净率98．4％（184／187）。结论钬激光碎石术治疗泌尿系结石疗高效、微创、安全，是输尿管结石和膀胱结石首选治疗方法。

Holmium laser lithotripsy for the treatment of urinary calculi: Report of 1216 cases

Objective To evaluate the efficacy and safety of holmium laser lithotripsy for the treatment of urinary calculi.Methods A total of 1216 cases of urinary calculi underwent ureteropyeloscopic and cyctocopic holmium laser lithotripsy.There were 1 006 cases of ureteral stones(302 cases of upper ureteral stones,364 cases of middle ureteral stones,and 340 cases of lower ureteral stones) and 210 cases of bladder stones.Results In 1 case of upper ureteral stones,failure to access the ureteral orifice due to enlarged prostate was encountered,and extracorporeal shock wave lithotripsy(ESWL) was employed.In 1006 cases of ureteral stones,the rate of successful fragmentation on single session was 95.5%(961/1 006),with 89.4%(270/302),96.4%(351/364),and 100%(340/340) for upper,middle,and lower ureteral stones,respectively.Ureteral perforation was encountered during lithotripsy in 6 cases.In 210 cases of bladder stones,the rate of successful fragmentation on one session was 100%(210/210).No bleeding or bladder perforation was observed during lithotripsy.Follow-up checkups for 0.5~40 months(mean,18.6 months) in 881 cases of ureteral stones showed that the stone-free rates were 91.1%(224/246),98.5%(318/323),and 100%(312/312) for upper,middle,and lower ureteral stones,respectively.The overall stone-free rate for all levels of ureteral stones achieved 96.9%((854/881)).Ureteral stenosis was found in 6 cases.Follow-up checkups for 0.5~31 months(mean,12.4 months) in 187 cases of bladder stones revealed a stone-free rate of 98.4%(184/187). Conclusions Holmium laser lithotripsy is a highly effective,minimally invasive,and safe therapy for urinary calculi.It is indicated as the first choice of treatment for patients with ureteral stones and bladder stones.