应用U?100激光腔内碎石术治疗输尿管及膀胱结石的临床观察

【摘要】  目的 探讨输尿管镜下应用U?100激光输尿管及膀胱结石的疗效。方法 对25例输尿管结石和5例膀胱结石患者在输尿管镜下应用U?100激光进行碎石治疗。术中激光输出功率为120 mj，频率为3~5 Hz，输尿管结石患者术中均留置“双J”管引流，4周后拔除。结果 23例输尿管结石及5例膀胱结石患者一次碎石成功，72 h 内排尽结石。有2例输尿管上段结石患者1例术中结石移入肾盂，另1例激光碎石无效，术后均行ESWL治疗成功。U?100激光碎石成功率达93．3%。全部碎石成功的患者术后除出现血尿以外，无其他明显并发症出现。结论 输尿管镜下应用U?100激光碎石是一种快速，高效，安全，微创的腔内碎石方式。

【关键词】  U?100激光；激光碎石；输尿管镜；输尿管结石；膀胱结石

　　Abstract： Objective  To evaluate the clinical use of ureteroscope U?100 laser lithotripsy on the treatment of ureter and bladder stones. Methods  Twenty?five cases of ureter stones and five cases of bladder stones were treated with ureteroscope U?100 laser lithotritor. The export power of the laser was 120mJ, the frequency of the laser was 3~5Hz. The double?J catheter was used for drainage after lithotripsy, and was pulled out four weeks later. Results  Twenty?three cases of uerter stones and five cases of bladder stones were successfully treated. The stones were ejected in 72 hours. One case with upper section stone of ureter was successful in pushing it into renal pelvis, and the other one failed to be treated by the U?100 laser. The successful rate of the U?100 laser lithotritor was 93.3%. All successful ones had no complications except haematuria. Conclusion  Treatment of ureter stones with ureteroscope U?100 laser lithotritor is quick, effective, safe and less invasive.

　　Key  words： U?100 laser; laser lithotripsy; ureteroscope; ureter stone; bladder stone

     我院于2005年7—12月应用U?100激光腔内碎石治疗输尿管结石25例，膀胱结石5例，治疗效果满意，有高效，安全，快速等优点，现将治疗结果报告如下。

　　1  资料与方法

　　1．1  临床资料 

　　本组30例患者中男性 18例，女性12例，年龄18~76岁，平均36．5岁，左侧输尿管结石15例，右侧输尿管结石10例，膀胱结石5例，输尿管上段结石7例，输尿管下段结石18例，结石直径1．2~3．0 cm，平均1．9 cm。所有输尿管结石患者术前均行ESWL治疗，效果欠佳，其中2例患者输尿管内形成石街。

　　1?2  治疗方法
 
　　应用德国W．0．M公司生产的U?100双波长激光碎石机，德国WOLF 8/9．8Fr10度输尿管硬镜，病人在连续硬膜外麻醉下（除1例患者因脊柱严重弯曲行全麻）进行碎石。术中激光功率设置为120 mj，频率为3~5 Hz。患者均取截石位，自尿道外口插入输尿管镜，在斑马导丝引导下将输尿管镜顺利插入患侧输尿管内，找到结石后插入激光传导光纤，如为1 cm 以下的小结石可从结石中央将其击碎。对>1 cm 的结石可先从结石边缘小块状击碎，待剩余一半大小时从中央将其完全击碎。碎石完全后在斑马导丝引导下逆行插入“双J”管，并留置导尿管持续膀胱冲洗。导尿管术后3~5 d 拔除，双J管术后4周拔除。