CAJ | 학술논문

目的：探讨输尿管软镜配合钬激光在肾结石治疗中的疗效。方法采用输尿管软镜配合钬激光治疗肾结石34例，其中单侧肾结33例，双侧肾结石1例；肾上盏结石11例，中盏结石9例，下盏结石3例，肾盂结石12例；结石大小为1．2～2．0 cm，平均1．65 cm。逆行输尿管软镜下经输尿管硬镜扩张输尿管后，留置输尿管鞘，使用200μm光纤。设置最大功率25 W（1．5 J×10 Hz）行钬激光碎石，或先期留置双J管扩张输尿管，2周后再逆行输尿管软镜下钬激光碎石。结果24例一期置双J管2周，二期均进镜成功，置镜成功率为100％。10例一期一次进镜，成功6例，置镜成功率为60％。34例中除3例肾下盏结石未处理外，均顺利进行碎石治疗，碎石治疗率为91．1％。手术时间为40～100 min，平均为60 min。住院时间5～8 d，平均6 d。发生感染性休克1例。出现发热、腰部疼痛1例。术后4周复查B超结石清除率为93．5％。结论输尿管软镜下钬激光治疗肾结石微创、安全、疗效好，并发症少，是肾结石治疗的一种理想选择。
목적：탐토수뇨관연경배합화격광재신결석치료중적료효。방법채용수뇨관연경배합화격광치료신결석34례，기중단측신결33례，쌍측신결석1례；신상잔결석11례，중잔결석9례，하잔결석3례，신우결석12례；결석대소위1．2～2．0 cm，평균1．65 cm。역행수뇨관연경하경수뇨관경경확장수뇨관후，류치수뇨관초，사용200μm광섬。설치최대공솔25 W（1．5 J×10 Hz）행화격광쇄석，혹선기류치쌍J관확장수뇨관，2주후재역행수뇨관연경하화격광쇄석。결과24례일기치쌍J관2주，이기균진경성공，치경성공솔위100％。10례일기일차진경，성공6례，치경성공솔위60％。34례중제3례신하잔결석미처리외，균순리진행쇄석치료，쇄석치료솔위91．1％。수술시간위40～100 min，평균위60 min。주원시간5～8 d，평균6 d。발생감염성휴극1례。출현발열、요부동통1례。술후4주복사B초결석청제솔위93．5％。결론수뇨관연경하화격광치료신결석미창、안전、료효호，병발증소，시신결석치료적일충이상선택。
Objective To explore the efficiency of flexible ureteroscopy combined with holmium laser for renal stones. Methods The 34 cases of renal stones were treated with flexible ureteroscope combined with holmium laser. Among 34 cases 33 were unilateral kidney,1 was bilateral kidney stones;11 cases in upper calyx, 9 in middle calyx,3 in low calyx,12 in pelvic stones. The calculi diameter ranged from 1.2 to 2.0 cm (averaged 1.65 cm). After the ureter was dilated,the stones were fragmentized and removed by using 200 μm Ho:YAG laser(1.5J×10Hz),or,by early indwelling double J tube expansion of the ureter,after 2 weeks lithotripsy. Results The 24 cases received the first phase of double J tube for 2 weeks,then flexible ureteroscopy were placed successfully into ureter,the success rate was of 100%. Rest 10 cases received once into ureter rimarily,6 were of success,the success rate was 60%. Except 3 cases of renal calyx calculi under untreated,the operations of 31 cases were smoothly carried on;treatment rate was 91.1%. Operating time was 40-100 min (averaged 60 min). The mean hospital stay of patients was 6 days(5-8 days). Septic shock occurred in 1 case,fever,waist pain in 1 case. Four weeks after review of ultrasound stone clearance rate was up to 93.5%. Conclusion Flexible ureteroscopy combined with holmium laser is a minimally invasive,safe,good curative effect with fewer complications.It is a kind of ideal choice for treatment of renal stones.