CAJ | 학술논문

目的探讨组合式输尿管软镜U100激光碎石术在肾结石治疗中的疗效和安全性.方法接受经尿道输尿管软镜U100激光碎石术患者42例,男24例,女18例；19 ～73岁,平均(40.71 ±14.08)岁；主要结石位于肾盂8例、上盏10例、中盏13例、肾下盏11例；结石单发30例,多发12例.结石直径均在2cm以下.全身麻醉,截石位.直视下输尿管硬镜插入斑马导丝并扩张输尿管,置入输尿管软镜鞘,置入输尿管软镜,见结石后插入U100激光光纤,将结石粉碎成直径＜2mm的颗粒.术中留置D-J管,术后4～6周拔除D-J管.术后1周均复查KUB,术后3个月复查KUB+ⅣU或B超.结果 1例进镜失败者在成功留置导丝的前提下放置双J管,2周后成功进镜.1例进镜失败无法留置导丝中转开放手术,1例多发结石主要结石未寻到行开放手术.一次进镜成功率为95.2％ (40/42),39例软镜成功进镜后寻及结石,结石寻及率97.5％(39/40),其中35例成功碎石(一次成功率89.7％).输尿管软镜手术时间30 ～90min.术后住院2～7天.无输尿管穿孔、撕脱等严重并发症.术后高热8例.结论组合式输尿管软镜U100激光碎石术治疗肾结石安全、有效,疗效可靠,在处理肾中、上盏结石上疗效显著.尤其适用于结石体积较小、肾盏无明显积水者.因成本较低廉,更适用于输尿管软镜技术开展的前期阶段.
목적 탐토조합식수뇨관연경U100격광쇄석술재신결석치료중적료효화안전성.방법 접수경뇨도수뇨관연경U100격광쇄석술환자42례,남24례,녀18례；19 ～73세,평균(40.71 ±14.08)세；주요결석위우신우8례、상잔10례、중잔13례、신하잔11례；결석단발30례,다발12례.결석직경균재2cm이하.전신마취,절석위.직시하수뇨관경경삽입반마도사병확장수뇨관,치입수뇨관연경초,치입수뇨관연경,견결석후삽입U100격광광섬,장결석분쇄성직경＜2mm적과립.술중류치D-J관,술후4～6주발제D-J관.술후1주균복사KUB,술후3개월복사KUB+ⅣU혹B초.결과 1례진경실패자재성공류치도사적전제하방치쌍J관,2주후성공진경.1례진경실패무법류치도사중전개방수술,1례다발결석주요결석미심도행개방수술.일차진경성공솔위95.2％ (40/42),39례연경성공진경후심급결석,결석심급솔97.5％(39/40),기중35례성공쇄석(일차성공솔89.7％).수뇨관연경수술시간30 ～90min.술후주원2～7천.무수뇨관천공、시탈등엄중병발증.술후고열8례.결론 조합식수뇨관연경U100격광쇄석술치료신결석안전、유효,료효가고,재처리신중、상잔결석상료효현저.우기괄용우결석체적교소、신잔무명현적수자.인성본교저렴,경괄용우수뇨관연경기술개전적전기계단.
Objectives To evaluate the clinical efficacy and complication with flexible ureteroscopic frequency-doubled-double pulse neodymium:YAG laser lithotripsy for renal calculi.Methods We applied a modular design,semidisposable flexible ureteroscope for the treatment of renal calculi in 42 patients consisting of 24 men and 18 female with a mean age of 40.71 years (19 to 73 years) by using flexible ureteroscopic lithotripsy with FREDDY laser.Among the cases,the main calculi located at the renal pelvis were 8,and the upper or middle calyx or the lower calyx werel0,13,11 respectively.30 cases had one stone but 12 in multiple calyxes,and the diameters of the stones were below 20mm.Rigid ureteroscope was inserted to observe and dilate the ureteral lumen after the trachea anesthesia with the lithotomic position.Then,a flexible ureteroscope was used.When the stone was seen,ureteroscopic FREDDY laser lithotripsy wan taken,setting the fiber diameter of FREDDY laser to 200 μm,and the output energy 120 mJ/cm2,pulse frequency 5 ～ 10 Hz.A pig-tail stent would be set at the end of the procedure and removed in 4 ～ 6 weeks after operation.A follow-up by KUB was done in 1 week and ultrasound or intravenous pyelography was taken in 12 weeks after the procedure to evaluate the result of the endoscopic nephrolithotripsy.Results In 1 patients the rigid ureteroscope couldnt be inserted in the first time,the reureteroscopy was successful in the patient after 2 weeks.The were 2 turned to open operation.The success rate of the ureteroscopic insertion was 95.2％ (40/42) and the successful rate of stone search was 97.5 ％.The successful rate of stone fragmentation after single session was 89.7 ％ (35/39).Operation time was 30 ～90 min.Time of postoperative stay in hospital was 2 ～ 7 days.No ureteral perforations occurred.Hyperthermia happened in 8 patients.Conclusions The FREDDY laser lithotripsy through the modular flexible ureteroscope is a safe,effective treatment modality for the upper or middle calyceal calculi,especially for those with minor diameter and without significant hydronephrosis.It should be recommended especially for promoting the flexible ureteroscope technology in development stage because of the poor repair cost.