Experience of treatment of the patients with the 1st-stage of ureteral calculus above L4 with a high lithotripsy rate by trans-urethral ureteroscopy holmium laser
Yu Ji1, Liu Weijun1, Li Jin1, Shi Lei1, Luo Chengbin1, Liu Xiaoping1
1 Department of Urology, Central Hospital of Xiangtan, Xiangtan 411101, China
Abstract：Objective:To summarize the experiences of treatment of the patients with the 1st-stage of ureteral calculus above L4 with a high lithotripsy rate by trans-urethral ureteroscopy holmium laser. Methods:269 cases of ureteral calculus who were treated by trans-urethral ureteroscopy holmium laser through a modification of intraoperative technique from Dec. 2011 to Jun, 2016 were retrospectively analyzed, among them, there were 184 cases whose calculus was more than 4 cm away from the pelvis-ureter junction, and 85 cases whose calculus was equal to or less than 4 cm away from the pelvis-ureter junction. The maximum diameter of calculus was measured as 0.8-1.8 cm, averagely (1.2±0.2) cm, and collective systematic separation was 12-50 mm, averagely (20±4) mm. Results:There were 184 cases whose calculus was more than 4 cm away from the pelvis-ureter junction, and 168 cases were successfully cured by one-stage operation with the calculus clearance rate being 91.3%. There were 2 cases of N-shaped ureteral distortion, which were changed to receive a percutaneous renal lithotripsy to remove the calculus. There were 14 cases whose calculus was incompletely removed, and the remaining calculus needed to be treated by extracorporeal shock wave lithotripsy (ESWL). There were 85 cases whose calculus was equal to or less than 4 cm away from the pelvis-ureter junction, and 64 cases were successfully cured by one-stage operation with the calculus clearance rate being 75.3%. There were 5 cases of N-shaped ureteral distortion, which were changed to receive a percutaneous renal lithotripsy to remove the calculus. There were 16 cases whose calculus was incompletely removed, and the remaining calculus needed to be treated by ESWL. Conclusions:A high calculus clearance rate can be achieved by the trans-urethral ureteroscopy with a consideration of preoperative examination and intraoperative operational details in treating the L4-above ureteral calculus, which can be regarded as a preferential program characterized with less injury, convenient operation, short duration and relatively low cost.
於佶, 刘伟军, 李进, 石磊, 罗成斌, 刘小平. 经尿道输尿管硬镜钬激光处理L4以上输尿管结石一期高碎石率[J]. 微创泌尿外科杂志, 2017, 6(3): 154-157.
Yu Ji, Liu Weijun, Li Jin, Shi Lei, Luo Chengbin, Liu Xiaoping. Experience of treatment of the patients with the 1st-stage of ureteral calculus above L4 with a high lithotripsy rate by trans-urethral ureteroscopy holmium laser. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2017, 6(3): 154-157.
[1] 黄河,申隆江,彭洪亮,等.102 例输尿管上段结石4种治疗方法疗效比较.当代医学,2013,19(11):41-43. [2] 操作亮,章传华,袁敬东.输尿管镜碎石术中肾盂内压力变化对术后发热的影响.临床泌尿外科杂志,2013,28(2):120-122. [3] 邓景球,李宋荣,史向民,等.经皮肾取石和输尿管镜碎石治疗嵌顿性输尿管上段结石的疗效比较.中华腔镜泌尿外科杂志(电子版),2009,3(6):222-224. [4] Yan Z, Xie G, Yuan H, et al. Modular flexible ureteroscopy and holmium laser lithotripsy for the treatment of renal and proximal ureteral calculi: A single-surgeon experience of 382 cases. Exp Ther Med, 2015,10(4):1467-1471. [5] 陈智勇,杨中青,高宁,等.输尿管上段结石的微创治疗(349 例经验总结).中国内镜杂志,2011,17(6):647-649. [6] 郭景阳,杨文增,张彦桥,等.无管化组合式输尿管软镜超微经皮肾通道治疗小儿输尿管上段结石的疗效观察.中国内镜杂志,2016,22(7):90-93. [7] 曾文广.输尿管镜治疗输尿管上段结石分析.当代医学,2011,17(12):105-106. [8] 尤平洪,谭锐,戴庆德,等.输尿管镜下钬激光和气压弹道治疗输尿管上段结石的疗效比较.西部医学,2012,24(2):276-277. [9] 赵晓风,张豫才,潘家波,等.联合应用钬激光及套石篮与单用钬激光在经尿道输尿管镜治疗输尿管上段结石的比较研究.中国微创外科杂志,2011,11(6): 554-556. [10] 高晓康,董焱鑫,钱云程,等.NTrap 结石拦截网在输尿管镜下钬激光碎石治疗输尿管上段结石中的应用.中国微创外科杂志,2012,12 (6):527-529. [11] 顾炜,徐耀庭,许晓文,等.拦截网篮或封堵器和无封堵装置在治疗输尿管上段结石手术中的前瞻性比较.中华腔镜泌尿外科杂志(电子版),2014,8(2):85-88. [12] Akdeniz E, ⅰrkılata L, Demirel HC, et al. A comparison of efficacies of holmium YAG laser, and pneumatic lithotripsy in the endoscopic treatment of ureteral stones. Turk J Urol, 2014,40(3):138-143. [13] 李涵,王坤杰,胡兴平.输尿管镜术治疗输尿管上段结石有效性和安全性的Meta分析.中国循证医学杂志,2014,14(9):1119-1125. [14] 陆佳荪,温机灵,温晓飞,等.经输尿管镜治疗输尿管上段结石失败原因的分析及对策.中华腔镜泌尿外科杂志(电子版),2010,4(2):116-118. [15] 王大伟,鲁军,夏术阶,等.输尿管上段结石经输尿管镜碎石失败66例再治疗经验.中国微创外科杂志,2007,7(9):899-901. [16] 刘定益,王健,王名伟,等.提高输尿管镜钬激光治疗输尿管上段结石成功率的体会.临床泌尿外科杂志,2010,25(3):189-191.
