沈乾+刘星明+任胜强+桑乾宏+王强辉+梁宇+徐立奇+李春强

【摘要】 目的：探讨封堵导管结合钬激光在输尿管镜下治疗输尿管上段结石的应用效果。方法：回顾性分析在输尿管镜钬激光碎石术中使用封堵导管的152例输尿管上段结石患者的临床资料。结果：152例中，143例一次碎石成功（94.1%），术中结石漂移至肾盂或肾盏内8例（5.2%），1例因输尿管上段扭曲输尿管镜无法进入。其中143例患者，将结石粉碎至约2 mm左右，无明显手术并发症，术后2～4周复查CT未见明显碎石。结论：封堵导管结合钬激光在输尿管镜下治疗输尿管上段结石可减少结石上移，提高结石清除率，值得临床推广。

【关键词】 上尿路结石； 封堵导管； 钬激光碎石； 输尿管镜

doi：10.14033/j.cnki.cfmr.2017.11.059 文献标识码 B 文章编号 1674-6805（2017）11-0107-03

Application of Transcatheter Closure Combined with Holmium Laser Lithotripsy in the Treatment of Upper Ureteral Calculi/SHEN Qian，LIU Xing-ming，REN Sheng-qiang，et al.//Chinese and Foreign Medical Research，2017，15（11）：107-109

【Abstract】 Objective：To investigate the effect of transcatheter closure combined with holmium laser lithotripsy in the treatment of upper ureteral calculi.Method：Retrospective analysis of clinical data of 152 patients with upper ureteral calculi who were treated with transcatheter closure of ureteral calculi with holmium laser lithotripsy.Result：In 152 cases，there were 143 cases of a graveled success（94.1%）.There were 8 cases（5.2%） with stones drifting to the renal pelvis or renal calyx during the operation. And 1 case was unable to enter because of ureter distortion.Among the 143 patients，crushed stones to about 2 mm or so，without obvious surgical complications.After 2 to 4 weeks，there were no obvious crushed stones on CT.Conclusion：Transcatheter closure combined with holmium laser lithotripsy in the treatment of upper ureteral calculi can reduce the stone up and improve the stone clearance rate，isworth of clinical promotion.

【Key words】 Upper ureteral calculi； Transcatheter closure； Holmium laser lithotripsy； Ureteroscope

First-authors address：The 113rd Hospital of PLA，Ningbo 315040，China

輸尿管镜钬激光碎石术治疗输尿管结石在临床上已广泛应用，可是对于输尿管上段结石，因碎石过程中容易上移至肾盂内，所以碎石成功率、清除率不是很高。封堵导管可有效防止输尿管上段结石上移，使碎石成功率、清除率有了很大提高。本文主要报道封堵导管结合钬激光在输尿管镜下碎石治疗输尿管上段结石中的应用效果。

1 资料与方法

1.1 一般资料

收集笔者所在医院2013年7月-2016年7月住院治疗的152例输尿管上段结石患者，男85例，女67例；年龄18～75岁，平均39岁。结石位置：左侧69例，右侧80例，双侧3例。结石直径5～11 mm，纵径6～19 mm。其中68例患者曾行体外冲击波碎石术治疗，碎石效果不佳。

1.2 仪器设备

封堵取石导管，为上海英诺伟医疗器械有限公司生产，由叶片、导丝、外管、手柄等构成。……