CAJ | 학술논문

目的探讨输尿管镜下2μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石的安全性和有效性.方法 2007年6月至2010年3月收治肉芽包裹性输尿管结石38例.男20例,女18例.平均年龄47(21～76)岁.左侧17例,右侧21例.肾积水中度24例,重度14例.肾盂分离平均3.8(2.1～7.2)cm.输尿管硬镜下,先用2 μm激光汽化切除结石下方炎性肉芽,显露结石,再用EMS碎石清石系统碎石,统计分析碎石率、排石率和并发症.结果原位碎石成功35例(92%).碎石时间平均(23.0±6.5)min;术中出血量平均(7.0±4.5)ml;术后住院时间平均(5.2±0.6)d.2例结石上移至肾盂,留置支架管后辅以ESWL碎石,1例输尿管狭窄置镜失败改开放手术.术后1个月复查,结石排净32例(86%),平均随访8(3～15)个月,未出现输尿管狭窄,尿路感染等并发症.结论输尿管镜下2 μm激光联合气压弹道碎石治疗肉芽包裹输尿管结石安全、高效,可作为这类病例的首选治疗手段.
목적 탐토수뇨관경하2μm격광연합기압탄도쇄석치료육아포과수뇨관결석적안전성화유효성.방법 2007년6월지2010년3월수치육아포과성수뇨관결석38례.남20례,녀18례.평균년령47(21～76)세.좌측17례,우측21례.신적수중도24례,중도14례.신우분리평균3.8(2.1～7.2)cm.수뇨관경경하,선용2 μm격광기화절제결석하방염성육아,현로결석,재용EMS쇄석청석계통쇄석,통계분석쇄석솔、배석솔화병발증.결과 원위쇄석성공35례(92%).쇄석시간평균(23.0±6.5)min;술중출혈량평균(7.0±4.5)ml;술후주원시간평균(5.2±0.6)d.2례결석상이지신우,류치지가관후보이ESWL쇄석,1례수뇨관협착치경실패개개방수술.술후1개월복사,결석배정32례(86%),평균수방8(3～15)개월,미출현수뇨관협착,뇨로감염등병발증.결론 수뇨관경하2 μm격광연합기압탄도쇄석치료육아포과수뇨관결석안전、고효,가작위저류병례적수선치료수단.
Objective To investigate the therapeutic effects, safety of ureteral calculus accom panied with granulation treated with pneumatic lithotripsy and two-macron laser via transurethral uret eroscopic. Methods From June 2007 to March 2010, 38 cases of ureteral calculus accompanied with granulation were treated with 2 μm laser and pneumatic lithotripsy via ureteroscope. All the patients had middle to severe hydronephrosis. The granulation under the calculus was vaporized with the 2 μm laser, and then the ureteral stone was fragmented with pneumatic lithotripsy. The clinical datum,stone disintegration rate, lithagogue rate and complication were retrospectively analyzed. Results Among 38 cases of ureteral stones, rate of successful fragmentation in a single procedure was 92%(35/38). The operation time ranged from 15 to 45 min, mean (23.0±6.5)min. Estimated the intraoperative blood loss was (7.0±4.5)ml. The postoperative hospitalization time was (5.2±0.6)d. Two upper ureteral stones were pushed back to the renal pelvis and a conversion to extracorporeal shock wave lithotripsy (ESWL) was needed. The insertion of the ureteroscope was failed in 1 case who was accepted open operation finally. Among the 37 cases treated via ureteroscopy, stone clearance rate was about 86% after operation 1 month. Follow-up examinations for 3-15 months (mean 8 months)showed no ureteral stenosis or urinary infection. Conclusion 2 μm laser and pneumatic lithotripsyvia ureteroscope could be a highly effective and safe therapy for treatment of ureteral stone with granulation.