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目的探讨Ⅰ期输尿管软镜下钬激光治疗直径<2cm肾结石的安全性和有效性。方法回顾性分析2016年4月至2017年5月期间本科输尿管软镜钬激光碎石术病例36例,其中男性17例,女性19例,Ⅰ期手术20例,Ⅱ期手术16例,结石直径0.6~2.0cm,平均1.2cm。全麻下使用STORZ Flexible-X 7.5Fr输尿管软镜寻找到结石,使用200μm激光光纤,调节功率为0.8~1.0 J/10~15Hz碎石。术后均留置双J管至术后4周拔出,1个月后复查CT评估手术效果。结果 36例患者均顺利完成手术,手术时间35~60分钟,平均50分钟。Ⅰ期碎石成功率90%(18/20)。2例患者Ⅰ期置镜失败留置双J管10~14天后改行Ⅱ期手术,Ⅱ期手术成功率100%(18/18)。术中无明显出血,术后住院时间2~5天,平均3天。1例女性患者术后反复发热加强抗感染治疗后治愈。拔出双J管后1个月复查CT,其中有5例残留<0.4cm结石,2例位于肾下盏,3例位于多肾盏。结论对结石直径<2cm肾结石Ⅰ期碎石成功率高,安全有效。
Objective To investigate the safety and efficacy of primary ureteroscopic holmium laser in the treatment of renal calculi with diameter less than 2 cm. Methods Retrospective analysis of 36 cases of undergraduate ureteroscopic holmium laser lithotripsy from April 2016 to May 2017, including 17 males and 19 females, 20 cases of stage Ⅰ surgery, 16 cases of stage Ⅱ operation, 0.6 ~ 2.0cm, average 1.2cm. Under general anesthesia, STORZ Flexible-X 7.5Fr ureteroscope was used to find the stones. Using 200μm laser fiber, the power was adjusted to 0.8-1.0 J / 10-15Hz gravel. All patients were placed double J tube until 4 weeks after the operation, and CT was evaluated after 1 month. Results All the 36 patients completed the operation successfully. The operation time was 35-60 minutes with an average of 50 minutes. Ⅰ gravel success rate of 90% (18/20). Two cases of patients with stage Ⅰ misdoscope were placed in double J tube for 10 to 14 days and then transferred to stage Ⅱ operation. The success rate of stage Ⅱ operation was 100% (18/18). No intraoperative bleeding, postoperative hospital stay of 2 to 5 days, an average of 3 days. One case of female patients cured after repeated fever and anti-infective therapy. Pull out the double J tube 1 month after the review of CT, of which 5 cases of residual <0.4cm stones, 2 cases located in the lower extremities, 3 cases located in multiple calyces. Conclusions The success rate of stage Ⅰ lithotripsy of renal calculi with diameter <2cm is high, safe and effective.