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探讨采用F8组合式输尿管软镜(MURF)联合钬激光碎石术处理上尿路结石的临床价值。2014年5月至2014年12月入选上尿路结石患者31例,男24例,女7例,年龄范围为19至71岁。其中近段输尿管结石5例;近段输尿管结石合并肾上、中及下盏结石各1例;上盏结石6例;中盏结石7例;下盏结石5例;肾盂结石7例。此外,左侧上尿路结石结石23例,右侧为8例。结石大小范围为1.0cm至2.0cm,平均(1.72±0.54)cm。脊麻或全麻下,取截石位,镜下寻见输尿管开口,置入斑马导丝,并沿导丝,推wolf输尿管硬镜(F8/9.8)入输尿管内,直达肾盂。镜下检查肾盏的大致分布后,退出输尿管硬镜,沿导丝置入输尿管管鞘(UAS cook F12/14),输尿管管鞘近端至肾盂输尿管连接部;沿输尿管管鞘置入组合式URDF,并入肾盂,寻找到结石后用200μm钬激光将结石击碎(激光功率在1.0J至2.0J范围,频率为10Hz至20Hz,将结石击碎为2mm至3mm颗粒,用套石篮将部分在4mm左右结石取出。术后常规留置F6号双J管3周,留置导尿1至2d。术后第1天行腹部平片检查。术后两周行B超检查。31例患者中有28例一次顺利置入UAS,3例留置双J管后2周顺利置入UAS。手术时间30min至80 min(平均40min)。碎石效果良好,一期碎石成功率74.19%(23/31),3例留置D-J管后二次软镜碎石成功,输尿管上段结石碎石成功率达100%(5/5),肾下盏结石碎石成功率40.00%(2/5)。采用F8组合式输尿答软镜处理上尿路结石安全、方便、疗效可靠,尤其在处理输尿管上段结石和肾孟及肾中盏、上盏结石上疗效显著。
To investigate the clinical value of using F8 combined ureteroscopic (MURF) and holmium laser lithotripsy in the treatment of upper urinary tract calculi. From May 2014 to December 2014, 31 patients with upper urinary tract stones were selected, including 24 males and 7 females, ranging in age from 19 to 71 years. The proximal ureteral calculi in 5 cases; proximal ureteral calculi with renal, middle and lower calculus in 1 case; upper calyx in 6 cases; calyx in 7 cases; lower calyx in 5 cases; 7 cases of renal pelvis. In addition, the left upper urinary tract stones in 23 cases, right in 8 cases. Stone size range 1.0cm to 2.0cm, with an average (1.72 ± 0.54) cm. Spinal anesthesia or under general anesthesia, take the lithotomy position, the ureter was found under the microscope opening, into the zebra guide wire, and along the guide wire, push wolf ureteroscopy (F8 / 9.8) into the ureter, directly to the renal pelvis. Microscopic examination of the approximate distribution of calyces, the exit of the ureteral hardcopy, along the guide wire into the ureteral sheath (UAScake F12 / 14), the proximal ureteropelvic tube to the ureteropelvic junction; along the ureteral sheath sheath combination URDF, into the renal pelvis, to find stones and holmium laser with 200μm crushed stones (laser power in the range of 1.0J to 2.0J, the frequency of 10Hz to 20Hz, the stones crushed into 2mm to 3mm particles, with a stone basket Some of the stones in about 4mm removed.Postoperative routine placement of F6 double J tube for 3 weeks, indwelling catheterization 1 to 2d.Postoperative day 1 abdominal plain film examination.After two weeks underwent B-mode ultrasound in 31 patients UAS was successfully established in 28 cases and UAS was successfully placed in 3 cases 2 weeks after the double J tube was placed in. The operation time was 30 min to 80 min (average 40 min). The gravel effect was good, the success rate of primary lithotripsy was 74.19% (23 / 31). The success of secondary soft-lens lithotripsy was achieved in 3 patients with DJ tube, the success rate of upper ureteral calculi was 100% (5/5), and the success rate of lower renal calculus was 40.00% (2/5) F8 combination of ureter soft lens treatment of upper urinary tract stones safe, convenient and reliable, especially in the treatment of upper ureteral calculi and kidney and kidney in the calyx, calyx stones on the curative effect Significant.