Chen Chih Shou, Wu Ching F, Shee Jia J, Lin Wei Y
Division of Urology, Department of Surgery, Chang Gung Memorial Hospital, Chia-Yi, Taiwan, R.O.C.
J Endourol. 2005 Sep;19(7):780-4. doi: 10.1089/end.2005.19.780.
Shockwave lithotripsy (SWL) has a variable but low success rate for impacted stones of the upper ureter. Ureterorenoscopic stone manipulation is another option, the appropriateness of which decreases with increasing size of the stone. This report examines the feasibility and effectiveness of ureterorenoscopic holmium:YAG lasertripsy (URSL) for impacted upper-ureteral stone >2 cm.
Twenty-six patients with impacted upper-ureteral stones >2 cm were treated with URSL using a 6/7.5F semirigid tapered ureterorenoscope and holmium:YAG laser under spinal anesthesia. Double-J ureteral stents were placed in all patients owing to the large stone burden and edema of the intraluminal mucosa. Success was defined as stone-free status on radiography at 1 month. Demographics, stone parameters, and outcomes were analyzed.
The retrograde accessibility rate of these stones was 96.2% (25 of 26). The stone-free rate achieved after one sitting was 84% (21 of 25). After an auxiliary treatment, the total stone free-rate reached 100%. In only one patient, who had a sharply angulated ureter, did access with the ureterorenoscope fail; this patient received open surgery. There were no intraoperative or postoperative complications.
Although 16% of patients need an auxiliary treatment, the holmium:YAG laser combined with a semirigid ureterorenoscope can be considered the first choice for large impacted upper-ureteral stones.
冲击波碎石术（SWL）治疗上段输尿管嵌顿结石的成功率不一且较低。输尿管镜取石术是另一种选择，但随着结石体积增大，其适用性会降低。本报告探讨输尿管镜钬激光碎石术（URSL）治疗直径>2 cm的上段输尿管嵌顿结石的可行性和有效性。
26例直径>2 cm的上段输尿管嵌顿结石患者，在脊麻下使用6/7.5F半硬性锥形输尿管镜和钬激光行URSL治疗。由于结石负荷大及管腔内黏膜水肿，所有患者均留置双J输尿管支架。成功定义为术后1个月X线检查结石清除。分析患者人口统计学资料、结石参数及治疗结果。
这些结石的逆行入镜成功率为96.2%（26例中的25例）。单次治疗后的结石清除率为84%（25例中的21例）。经过辅助治疗后，总结石清除率达到100%。仅1例输尿管呈锐角的患者输尿管镜入镜失败，该患者接受了开放手术。无术中及术后并发症。
虽然16%的患者需要辅助治疗，但钬激光联合半硬性输尿管镜可被视为治疗上段输尿管大嵌顿结石的首选方法。
