CAJ | 학술논문

目的探讨腔内钬激光治疗输尿管结石合并远端输尿管狭窄的临床疗效.方法 69例输尿管结石合并远端输尿管狭窄患者中,19例输尿管结石位于第3腰椎下缘以上合并远端输尿管狭窄患者采用微通道经皮肾镜钬激光碎石+输尿管狭窄扩张、钬激光内切开术,50例输尿管结石位于第3腰椎下缘以下合并远端输尿管狭窄患者采用经输尿管镜下钬激光碎石+输尿管狭窄扩张、钬激光内切开术.于术前和拔除双J管3个月后,复查B超、肾-输尿管-膀胱平片(KUB)+静脉尿道造影(IVU),观察肾积水程度、结石排除情况.结果 69例患者均成功手术,手术时间42～ 85(58±13) min.术中未发生大出血、输尿管断裂、输尿管撕脱、假道形成等;术后患者均有不同程度的肉眼血尿,68例2～3 d后消失;术后发热13例,予抗感染、对症治疗后缓解.碎石成功率95.7％(66/69),输尿管狭窄成功率97.1％(67/69).拔除双J管3个月后复查发现,结石已排除,未见残余结石,患者肾积水均明显减轻[术前肾集合系统扩张(22.0±8.2) mm,拔除双J管3个月后(12.0±6.1)mm,差异有统计学意义(t=8.52,P＜0.01)].结论采用微通道经皮肾镜钬激光碎石或经输尿管镜下钬激光碎石+输尿管狭窄扩张、钬激光内切开术治疗输尿管结石合并远端输尿管狭窄,术中、术后未发生严重并发症,手术时间短、费用低、手术安全,取得了满意的疗效,是一种治疗输尿管结石合并远端输尿管狭窄值得推荐的方法.
목적 탐토강내화격광치료수뇨관결석합병원단수뇨관협착적림상료효.방법 69례수뇨관결석합병원단수뇨관협착환자중,19례수뇨관결석위우제3요추하연이상합병원단수뇨관협착환자채용미통도경피신경화격광쇄석+수뇨관협착확장、화격광내절개술,50례수뇨관결석위우제3요추하연이하합병원단수뇨관협착환자채용경수뇨관경하화격광쇄석+수뇨관협착확장、화격광내절개술.우술전화발제쌍J관3개월후,복사B초、신-수뇨관-방광평편(KUB)+정맥뇨도조영(IVU),관찰신적수정도、결석배제정황.결과 69례환자균성공수술,수술시간42～ 85(58±13) min.술중미발생대출혈、수뇨관단렬、수뇨관시탈、가도형성등;술후환자균유불동정도적육안혈뇨,68례2～3 d후소실;술후발열13례,여항감염、대증치료후완해.쇄석성공솔95.7％(66/69),수뇨관협착성공솔97.1％(67/69).발제쌍J관3개월후복사발현,결석이배제,미견잔여결석,환자신적수균명현감경[술전신집합계통확장(22.0±8.2) mm,발제쌍J관3개월후(12.0±6.1)mm,차이유통계학의의(t=8.52,P＜0.01)].결론 채용미통도경피신경화격광쇄석혹경수뇨관경하화격광쇄석+수뇨관협착확장、화격광내절개술치료수뇨관결석합병원단수뇨관협착,술중、술후미발생엄중병발증,수술시간단、비용저、수술안전,취득료만의적료효,시일충치료수뇨관결석합병원단수뇨관협착치득추천적방법.
Objective To evaluate the clinical efficacy of intracavitary holmium laser for ureter calculi combined with distal ureteral stricture.Methods Sixty-nine patients with ureteral calculi combined with distal ureteral stricture were selected.Nineteen patients with ureteral calculi above third lumbar vertebra inferior margin combined with distal ureteral stricture were given microchannel percutaneous nephroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision,and 50 patients with ureteral calculi below third lumbar vertebra inferior margin combined with distal ureteral stricture were given ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision.The type-B ultrasonic,kidney-ureter-bladder plain film (KUB) + intravenous urography (IVU) were performed before operative and 3 months after removal of double J tube,and the degree of hydronephrosis and calculi removal condition were observed.Results The operations of all the patients were successful,and operation time was 42-85 (58 ± 13) min.Intraoperative hemorrhoea,ureteral rupture,ureteral avulsion,false passage formation did not occur.All patients had varying degrees of gross hematuria after operation,and 68 cases disappeared after 2-3 d.Thirteen cases had postoperative fever,and these patients were alleviated after the anti-infection and symptomatic treatment.The success rate of gravel was 95.7％ (66/69),and the success rate of ureteral stricture was 97.1％ (67/69).Three months after removal of double J tube,calculi had been discharged,with no residual calculi.The patients' hydronephrosis was obviously alleviated.The extension of renal collecting system was (22.0 ± 8.2) mm before operation,and was (12.0 ± 6.1) mm 3 months after extraction double J tube,and there was statistical difference (t =8.52,P ＜ 0.01).Conclusions The nicrochannel percutaneous nephroscope holmium laser lithotripsy or ureteroscope holmium laser lithotripsy + ureteral stricture dilatation and holmium laser incision for ureteral calculi combined with distal ureteral stricture patients has no serious intraoperative and postoperative complications,shorter operation time,low cost,operation safety,and satisfactory effect.It is a good method for ureteral calculi combined with distal ureteral stricture.