厉莎莎 赵炎 梁杰 董宇宁

摘要：目的  探讨双侧输尿管结石行双侧输尿管镜下钬激光碎石手术的清石率及安全性。方法  回顾性分析2014年9月～2018年8月于我院行输尿管镜钬激光碎石术同期治疗双侧输尿管结石34例患者的临床资料，分析手术时间、住院时间、并发症及结石清除率情况。结果  34例患者手术时间（58.43±14.82）min，住院时间（1.24±0.52）d，其中术后发热2例，血尿2例;34例患者共有输尿管结石82枚，其中输尿管下段结石55枚，中段结石11枚，上段结石16枚，总清石率为92.68%，下段结石清除率为96.36%，中段结石清除率91.91%，上段结石清除率81.25%。结论  输尿管镜同期治疗双侧输尿管结石清石效果确切，安全性高，并发症少，是一种可靠的双侧输尿管结石处理方案。

关键词：输尿管结石;钬激光碎石手术;输尿管镜;清石率

中图分类号：R699                                 文献标识码：A                                   DOI：10.3969/j.issn.1006-1959.2020.09.058

文章編号：1006-1959（2020）09-0180-03

Analysis of Clearing Rate of Ureteroscopy for Bilateral Ureteral Stones

LI Sha-sha，ZHAO Yan，LIANG Jie，DONG Yu-ning

（Department of Urology，Xuzhou Cancer Hospital，Xuzhou 221005，Jiangsu，China）

Abstract：Objective  To investigate the rate and safety of holmium laser lithotripsy under bilateral ureteroscopy for bilateral ureteral calculi.Methods  Retrospectively analyze the clinical data of 34 patients with bilateral ureteral calculi who underwent ureteroscopy holmium laser lithotripsy in our hospital from September 2014 to August 2018， and analyze the operation time， hospital stay， complications and stone removal rate.Results  34 patients had an operation time of （58.43±14.82）min and a hospital stay of（1.24±0.52）d， including 2 cases of postoperative fever and 2 cases of hematuria; 34 patients had a total of 82 ureteral stones， including 55 ureteral stones， 11 middle stones， and 16 upper stones，the total stone removal rate was 92.68%， the lower stone removal rate was 96.36%， the middle stone removal rate was 91.91%， and the upper stone removal rate was 81.25%.Conclusion  Ureteroscopy is effective in treating bilateral ureteral stones and clearing stones at the same time， with high safety and few complications. It is a reliable treatment method for bilateral ureteral stones.

Key words：Ureteral calculi;Holmium laser lithotripsy;Ureteroscopy;Clearing rate

输尿管结石（ureteral calculi）是泌尿外科常见病、多发病，可继发梗阻以及感染等。患者可能出现血尿、肾绞痛、恶心、呕吐及发热等症状。输尿管结石若双侧发病，有完全梗阻尿路导致急性肾衰竭的可能，此类患者一经诊断，往往需要急诊手术解除梗阻。目前，输尿管镜碎石术是一种微创治疗输尿管结石解除梗阻的高效手段。由于双侧同期输尿管镜手术处理双侧输尿管结石具有减少麻醉及手术次数、缩短住院时间、减少住院花费等优势，所以此种手术方式越来越多的受到临床关注[1，2]。然而，也有观点认为分期输尿管镜手术清石较为安全，双侧同期手术可能会增加手术相关风险并降低手术清石效果[3，4]。……