CAJ | 학술논문

目的：探讨输尿管软镜联合钬激光治疗婴幼儿上尿路结石的疗效和安全性。方法2014年6月至2014年12月我院采用输尿管软镜联合钬激光治疗20例婴幼儿上尿路结石，男性14例，女性6例，左侧、右侧、双侧；肾结石、输尿管结石；患儿平均年龄15（4～34）个月，结石平均直径1．5（0．5～3）cm。所有患儿均提前一周留置F4．7双J管，使用PO L Y组合式小儿输尿管软镜经导丝引导进入输尿管和肾盂内，不使用输尿管软镜输送鞘，软镜探查并以钬激光粉碎结石，激光功率为24～32 W ，术后常规留置双J管1个月。结果20例患儿共27例次手术均获得成功，平均手术时间35（20～50） min ，术中均无明显出血，术后均未留置导尿。所有患儿术后无感染和其他严重并发症发生，于术后第2～3天出院。14例患儿结石I期手术完全取净，6例分Ⅱ期手术先后处理输尿管结石和肾结石。结论输尿管软镜联合钬激光治疗婴幼儿上尿路结石具有较高的清石率和临床安全性。但需要充分的术前准备和细致的围手术期安全控制。
목적：탐토수뇨관연경연합화격광치료영유인상뇨로결석적료효화안전성。방법2014년6월지2014년12월아원채용수뇨관연경연합화격광치료20례영유인상뇨로결석，남성14례，녀성6례，좌측、우측、쌍측；신결석、수뇨관결석；환인평균년령15（4～34）개월，결석평균직경1．5（0．5～3）cm。소유환인균제전일주류치F4．7쌍J관，사용PO L Y조합식소인수뇨관연경경도사인도진입수뇨관화신우내，불사용수뇨관연경수송초，연경탐사병이화격광분쇄결석，격광공솔위24～32 W ，술후상규류치쌍J관1개월。결과20례환인공27례차수술균획득성공，평균수술시간35（20～50） min ，술중균무명현출혈，술후균미류치도뇨。소유환인술후무감염화기타엄중병발증발생，우술후제2～3천출원。14례환인결석I기수술완전취정，6례분Ⅱ기수술선후처리수뇨관결석화신결석。결론수뇨관연경연합화격광치료영유인상뇨로결석구유교고적청석솔화림상안전성。단수요충분적술전준비화세치적위수술기안전공제。
ABSTRACT:Objective To evaluate the efficacy and safety of flexible ureteroscopy (FURS) combined with holmium laser lithotripsy in the treatment of infants with upper urinary stones .Methods Clinical data of 20 infant patients with upper uri‐nary stones were treated with FURS and holmium laser lithotripsy at our hospital during June and Dec .2014 .Of all patients , 14 were male and 6 were female ,the mean age was 15 months (5~34 months) ,and the mean stone size was 1 .5cm (0 .5~3 cm) .Double J stent of F4.7 was indwelt in all patients a week in advance .The POLY flexible ureteroscope was directly placed into target ureter or renal pelvis alongside the operating guide wire without inserting the ureteral access sheath .The power of laser ranged from 24 to 32 W .A double J stent was left in place for 1 month in all cases routinely .Results All operations were successfully completed ,with an average operation time of 35 min (ranged 20 to 50 min) .No obvious intraoperative bleed‐ing occurred ,and no catheter was indwelt after operation .No postoperative infection or other severe complications were ob‐served .Of all cases ,14 were stone‐free after one‐stage operation while 6 underwent a second procedure to deal with stones in the renal pelvic and ureter respectively .Conclusions FURS combined with holmium laser lithotripsy produces high stone‐free rate and clinical safety for upper urinary stones ,but sufficient preoperative preparation and careful perioperative safety control are required .