输尿管软镜联合钬激光治疗有症状肾盏憩室结石 （附32例报道）

Flexible ureterorenoscopy with holmium laser in the management of symptomatic caliceal diverticular calculi (report of 32 cases)

摘要:

目的 评估输尿管软镜（F-URS）联合钬激光治疗有症状肾盏憩室（CD）结石的临床有效性与安全性。方法 对32例有症状的CD结石患者采用F-URS联合钬激光治疗。CD结石位于肾上盏20例，肾中盏7例，肾下盏5例。CD结石直径10～25 mm，平均（17.1±5.6）mm。蓝染技术寻及CD流出道，使用200/365μm光纤，0.8 J/10 Hz（8 W）功率适度扩大憩室流出道，0.8～1.5 J/10～25 Hz（10～35 W）功率碎石。结果 F-URS联合钬激光处理有症状CD结石成功率为81.3%（26/32），96.8%（31/32）术后症状消失。CD结石不同位置成功率差异无显著性（P >0.05），但憩室流出道短程（≤5 mm）成功率明显高于长程者（>5 mm）（P <0.05）。平均手术时间为71 min（56～125 min），住院时间1～4 d，平均3 d。术后有2例出现发热，无其他严重并发症。结论 F-URS联合钬激光可以选择性作为治疗有症状CD结石的一种有效方法，具有微创、安全及高效的优点。

Abstract:

【Objective】 To evaluate the clinical effects and operating experience of flexible ureterorenoscopy(F-URS) combined with holmium laser in the management of symptomatic caliceal diverticular(CD) calculi. 【Methods】 F-URS combined with holmium laser management was undertaken for 32 cases of symptomatic CD calculi. The diameter of the stones ranged from 10~25 mm with a mean of (17.1±5.6) mm. A 200-mm or 365-mm holmium laser fiber was used to incise the CD neck if needed and to fragment any CD stone by 200 or 365μm Ho: YAG laser with 0.8 J/10 Hz(8W). After the diverticular neck was dilated, the stones were fragmentized and removed by using 200 or 365μm Ho: YAG laser(0.8~25 J/10－25 Hz). 【Results】 Successful F-URS combined with holmium laser management was achieved in 26 cases (81.3%). In total, 31 (96.8%) patients were symptom free after the procedure. The stone free rate was independent on the different position of CD calculi(P >0.05), but varied with the distance of the diverticular neck(P <0.05). The operation time was 56~125 minutes with a mean of 71 minutes. The mean hospital stay of the patients was 3 days (1~4 days). After the operation, 2 patients suffered from fever, no severe complications were observed. 【Conclusion】 F-URS combined with holmium laser management is a safe,minimally invasive,and effective treatment for symptomatic CD calculi.