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目的探讨输尿管镜钬激光治疗输尿管结石并发输尿管穿孔的原因及防治方法。方法回顾性分析2004年8月至2006年12月经尿道输尿管镜钬激光碎石术268例中25例并发输尿管穿孔的临床资料。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1.2～3.2 cm,平均(1.8±0.5)cm,25例均合并输尿管息肉及中、重度肾盂积水。术后常规放置双J管4～8周。结果25例输尿管镜手术时间15～70 min,平均(40.4±8.3)min。11例一次性碎石成功,6例术中改开放取石治疗,8例结石上移至肾盂内,1周后予以体外冲击波碎石治疗。结论输尿管结石合并息肉是输尿管镜钬激光碎石致输尿管穿孔的主要原因之一,术中轻巧操作是预防出现输尿管穿孔的关键,早期及时开放手术可以避免严重并发症的发生。
Objective To investigate the causes of ureteroscopic holmium laser for ureteral calculi complicated with ureter perforation and its prevention and treatment. Methods The clinical data of 25 cases with ureter perforation in 268 cases of transurethral ureteroscopic holmium laser lithotripsy from August 2004 to December 2006 were retrospectively analyzed. There were 14 males and 11 females, 21 with calculi alone and 4 with multiple lesions. There were 18 cases of upper calculi and 7 cases of lower calculi. The diameter of stones was 1.2-3.2 cm (mean, 1.8 ± 0.5 cm) Polyps and moderate and severe hydronephrosis. After conventional double J tube placed 4 to 8 weeks. Results Twenty-five patients underwent ureteroscopic surgery for 15-70 min (mean, 40.4 ± 8.3) min. Eleven patients had a one-off gravel success. Six patients underwent open-cell lithotripsy and eight patients were transferred to the renal pelvis. One week later, extracorporeal shock wave lithotripsy was performed. Conclusions Ureteral calculi combined with polyps is one of the main causes of ureter perforation caused by ureteroscopic holmium laser lithotripsy. Intraoperative and light manipulation is the key to preventing perforation of ureter. Early and timely open surgery can avoid serious complications.