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目的探讨软性输尿管镜下钬激光碎石术治疗肾结石时,钬激光的最优参数设置。方法采用软性输尿管镜下钬激光碎石术治疗的肾结石患者289例。213例结石位于上盏、中盏或肾盂内,54例位于下盏,22例位于多个肾盏,均为单侧病变,结石直径为8~25 mm,平均直径(13.5±4.2)mm。术中根据结石硬度将钬激光功率设置为0.8~1.5 J/15~30 Hz(12~45 W)。在总功率一定时,将钬激光的参数设置为高频率和低能量,尽量将结石“粉末化”(即结石碎片直径<2 mm)。术后复查,如有直径>4 mm的结石碎片,则行二期软镜处理。结果 285例成功置入软性输尿管镜,总置镜成功率为98.6%(285/289),其中280例可行钬激光碎石治疗,总的结石清除率为98.9%(277/280)。手术时间(48.5±15.8)分钟,术后平均住院时间3.5天。27例(9.6%)患者术后出现Ⅰ~Ⅱ级并发症,无Ⅲ级及以上并发症发生。结论软性输尿管镜联合钬激光碎石是治疗肾结石安全有效的方法,采用合理的钬激光参数设置,可达到较高的结石清除率和较低的并发症发生率。
Objective To investigate the optimal parameters of holmium laser in the treatment of renal calculi with soft ureteroscopic holmium laser lithotripsy. Methods 289 cases of nephrolithiasis were treated with soft ureteroscopic holmium laser lithotripsy. Totally 213 stones were located in the upper cup, middle cup or pelvis, 54 in the lower cup and 22 in multiple calyces. All of them were unilateral lesions with diameter of 8-25 mm and mean diameter of (13.5 ± 4.2) mm. Intraoperative holmium laser power was set to 0.8 ~ 1.5 J / 15 ~ 30 Hz (12 ~ 45 W) according to the hardness of the stone. The total power at a certain time, the parameters of the holmium laser set to high frequency and low energy, as far as the stone “powder ” (ie, stone fragments <2 mm in diameter). Postoperative review, if the diameter of> 4 mm of stone fragments, then line two soft lens processing. Results 285 cases were successfully treated with ureteroscope. The total success rate was 98.6% (285/289). Among them, 280 cases were treated with holmium laser lithotripsy. The total stone clearance rate was 98.9% (277/280). The operation time (48.5 ± 15.8) minutes, the average postoperative hospital stay 3.5 days. Twenty-seven patients (9.6%) had grade Ⅰ ~ Ⅱ complications after operation, and no complications of grade Ⅲ or above occurred. Conclusions Soft ureteroscopy combined with holmium laser lithotripsy is a safe and effective method for the treatment of renal calculi. The reasonable setting of holmium laser parameters can achieve high stone clearance rate and low complication rate.