论文部分内容阅读
目的:探讨腔内钬激光治疗输尿管结石并发狭窄的处理策略。方法:收集36例输尿管镜下钬激光切开治疗输尿管结石并发狭窄患者的临床资料。结果:35例手术成功,1例单纯壁间段狭窄者予钬激光切开后仍无法上行,手术终止。术后共随访12～45个月,平均(23.8±9.5)个月。30例治愈或好转,有效率为83.3%(30/36)。6例无效(5例术后1～3个月结石复发,复行腔内激光手术,随访18～24个月,其中4例治疗有效,1例效果不佳。结论:经尿道钬激光碎石术(TUL)在治疗上尿路结石时可同时处理输尿管狭窄,是一种安全有效的手段。钬激光切开治疗狭窄的疗效(85.2%,23/27)要好于硬性扩张(77.8%,7/9),但两者比较无统计学意义(P>0.05)根据术中具体情况实施操作可能更具实用价值,不仅能够减少操作所需时间,且预后理想。我们倾向性认为中下段狭窄的预后(93.1%,27/29)较上段(57.1%,4/7)较好(P<0.05),但其处理方法选择标准及处理策略仍有待进一步探讨和完善。
Objective: To investigate the treatment of ureteral calculi complicated with stenosis by holmium laser. Methods: The clinical data of 36 patients undergoing ureteroscopic holmium laser incision for ureteral calculi complicated with stenosis were collected. Results: Thirty-five cases were successful. One patient with simple stenosed wall could not go up after holmium laser incision, and the operation was terminated. The patients were followed up for 12-45 months, with an average of (23.8 ± 9.5) months. 30 cases of cure or improvement, the effective rate was 83.3% (30/36). 6 cases were ineffective (5 cases of recurrence of stone 1 to 3 months after operation, laparoscopic laser surgery, followed up for 18 to 24 months, of which 4 were effective, 1 case of ineffective.Conclusion: Transurethral holmium laser lithotripsy (TUL) is a safe and effective method to treat ureteral stricture in the treatment of upper urinary calculi (85.2%, 23/27), which is better than that of rigid dilatation (77.8%, 7 / 9), but the difference was not statistically significant (P> 0.05). According to the specific circumstances of the operation may be more practical value, not only can reduce the time required for the operation, and the prognosis is ideal .We tend to think that the narrow prognosis (93.1%, 27/29) were better than those in the previous stage (57.1%, 4/7) (P <0.05). However, the selection criteria and treatment strategies of the treatment methods still need to be further explored and improved.