涂传全△ 孙颖浩 王锡智 廖国强 许传亮 陈文政

    [摘要] 目的 分析钬激光治疗输尿管结石过程中复杂问题和失败原因，寻找对策。方法 总结2003年12月至2005年12月间应用输尿管半硬镜下钬激光治疗输尿管结石564例612侧临床资料。结果 131例患者遇有复杂问题，40例治疗失败。其中，输尿管口进镜受阻16例，经扩张、电切输尿管开口通过。输尿管狭窄扭曲30例，经换用软镜、输尿管扩张、钬激光纵切狭窄环通过21例；余9例失败，其中4例放双J管后体外冲击波碎石（ESWL），3例放双J管1月后再次钬激光碎石成功，2例行输尿管切开取石术。结石或较大碎块（直径≥5mm）返回肾内56例，术中通过输尿管镜下碎石成功29例，余27例行术后ESWL。术中发现脓肾2例并停止碎石。术后发热(≥38℃)者25例，经抗感染治愈。术后排石受阻并再次输尿管镜下碎石2例。结论 钬激光碎石术治疗输尿管结石中有进镜受阻、结石易返回肾内、并发尿路感染等复杂问题，正确的处理可以提高手术成功率和减少手术风险。

    [关键词] 钬激光； 输尿管结石； 碎石术

    Treatment of the complicated questions in procedures of holmium laser lithotripsy for ureteral stontes. Tu Chuanquan, Sun Yinghao, Wang Xizhi, et al. Department of Urology, Second Medical University of PLA, Shanghai, 200433, China.

    [Abstract] Objective To find the solution through analyzing the complicated questions and the failure causes in the procedures of holmium laser lithotripsy for ureteral stones. Methods From Dec. 2003 to Dec. 2005, 564 consecutive patients ( 612 lateralis ) underwent semirigid ureterscopic lithotripsy with holmium laser for the ureteral stones. Results 131 patients had some different complicated questions. 40 cases were failed to complete the operation. The ureteroscope was blocked because of ureteral orifice ( 16 cases ) and passed through dilatation or cut by electricity. The ureteroscope was blocked because of ureteral stricture or incurvation ( 30 cases ). 21 cases were passed through changing semirigid ureteroscope into flexible ureteroscope, dilatation or longitudinal cut by holmium laser. 9 cases were failed to pass through the ureter. 4 of them were treated with extracorporeal shock wave lithotripsy(ESWL), 3 were performed lithotripsy again after placing Double J a month later, and the other 2 were treated with open surgery. Stones and large fragments ( Dia≥5mm ) which returned to the kidney were 56 in number. 29 of them were broken successfully by using the semirigid or flexile ureteroscope. The rest 27 were treated with ESWL. 2 patients were discoverded to suffer from pyonephrosis and the lithotripsys were stopped. 25 patients had fever (≥38℃) after operation and were cured by antibiotics. 2 stones, which were not expelled and blocked in the ureter after operation, were cleared away by ureterscopic lithotripsy with holmium laser again. Conclusions There are some questions, such as the ureteroscopic blocking, the returning of the stones, and the infection of the urinary tract, et al, in procedures of holmium laser lithotripsy for ureteral stontes. Correct treatment may incease the succsess rate and decrease the operating risk. ......