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目的探讨钬激光治疗输尿管结石并发输尿管穿孔的原因,提高对钬激光碎石术近期输尿管穿孔的防治水平。方法对该院2004年8月～2006年12月经尿道输尿管镜钬激光碎石术的268例中的25例并发输尿管穿孔患者的临床资料进行回顾性分析。男14例,女11例;结石单发者21例,多发者4例;上段结石18例,下段结石7例;结石直径1.2～3.2cm,平均(1.8±0.5)cm,均合并输尿管息肉及肾盂积水。术后常规放置双J管4～8周。结果25例输尿管镜手术时间15～70min,平均(40.4±18.3)min。11例一次性碎石成功,6例术中即时改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石(ESWL)治疗。结论输尿管结石合并息肉是钬激光碎石致输尿管穿孔的主要原因之一,轻柔而熟练的操作是预防和治疗输尿管穿孔的关键,早期及时开放手术可以避免其他更为严重并发症的发生。
Objective To investigate the causes of holmium laser in the treatment of ureteral calculi complicated with ureter perforation and to improve the prevention and treatment of the recent ureteral perforation in holmium laser lithotripsy. Methods The clinical data of 25 patients with ureteral perforation in 268 cases of transurethral ureteroscopic holmium laser lithotripsy from August 2004 to December 2006 in our hospital were analyzed retrospectively. There were 14 males and 11 females, 21 with calculi alone and 4 with multiple lesions. There were 18 cases of upper calculus and 7 cases of lower calculus. The diameters of stones ranged from 1.2 cm to 3.2 cm (mean 1.8 ± 0.5 cm) Hydronephrosis. After conventional double J tube placed 4 to 8 weeks. Results Twenty-five patients underwent ureteroscopy for 15-70 minutes, with an average of (40.4 ± 18.3) min. Eleven patients were successfully treated with one-off lithotripsy. Six patients underwent immediate open-calmactomy. Eight of the stones were transferred to the pelvis and one week later ESWL was performed. Conclusions Ureteral calculi combined with polyps is one of the main causes of ureter perforation caused by holmium laser lithotripsy. Gentle and skilled operation is the key to preventing and treating ureter perforation. Early and timely open surgery can avoid other more serious complications.