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目的探讨钬激光治疗泌尿系疾病的有效性和安全性。方法选择我院自2004年3月至2008年6月采用钬激光治疗泌尿系统疾病496例,并对之进行回顾分析。结果152例输尿管结石患者147例单次钬激光碎石成功,5例因输尿管口水肿无法置入输尿管镜术后半月再次行钬激光碎石成功。26例PCN患者,22例一次钬激光碎石彻底,4例因复杂肾结石保留肾造瘘管分次碎石。107例HoLEP术,103例手术一次成功,4例患者因术中类似表现TURS,手术暂停分期进行。70例膀胱肿瘤切除,57例一次成功。对分布广泛的9例多发性膀胱肿瘤采取分期分批切除法。43例尿道狭窄患者,36例随访3个月～3年效果满意。12例UPJ患者10例术后随访5个月～3年效果满意,2例因反复狭窄行开放UPJ肾盂整形。10例输尿管口囊肿均一次手术成功,术后9例获随访3～28个月,临床症状消失。12例尖锐湿疣患者一次性切除,术后配合药物辅助治疗,随访5～28个月无复发。结论钬激光是一种高效、安全、方便而性能稳定的医用激光,具有汽化、切割和凝固的多重特性,钬激光结合日渐成熟的泌尿腔内技术,其在泌尿外科的应用前景广阔。
Objective To investigate the efficacy and safety of holmium laser in the treatment of urinary diseases. Methods 496 cases of urinary system diseases were treated with holmium laser in our hospital from March 2004 to June 2008, and retrospectively analyzed. Results A total of 147 cases with ureteral calculi were successfully treated with holmium laser lithotripsy and 5 cases were treated with ureteroscopic holmium laser lithotripsy after ureteroscopic edema in 5 cases. 26 cases of PCN patients, 22 cases of primary holmium laser lithotripsy completely, 4 cases of renal calculi retained by renal fistula graded gravel. 107 cases of HoLEP surgery, 103 cases of a successful operation, 4 patients due to intraoperative similar performance TURS, surgery was staged. 70 cases of bladder tumor resection, 57 cases of a success. Nine cases of multiple bladder cancer widely distributed to take staged batch excision. 43 cases of urethral stricture, 36 cases were followed up for 3 months to 3 years with satisfactory results. Ten patients were followed up for 5 months to 3 years in 12 cases of UPJ. The results were satisfactory in 2 cases. UPJ renal pelvis was opened in 2 cases with recurrent stenosis. Ten cases of ureterocele were operated successfully, 9 cases were followed up for 3 to 28 months, the clinical symptoms disappeared. Twelve patients with condyloma acuminatum were removed at one time. After operation, they were treated with adjuvant drugs. No recurrence was observed in 5 to 28 months. Conclusion Holmium laser is a kind of medical laser with high efficiency, safety, convenience and stable performance. It has many characteristics of vaporization, incision and coagulation. Holmium laser combined with maturing urinary cavity technique has great potential in urology.