| [Objective] The urinary calculus is a common disease inurinary tract diseases,mostly for ureteral calculi,because ureteral calculi always can lead to ureter obstruction,and then lead to hydronephrosis and kidney damage,it needs active and effective treatment.Ureteroscope lithotripsy is an important way to treat ureteral stone,the current popular technologies are pneumatic lithotripay(PL) and holmium laser(HL).But PL has some shortcomings.For example,it is easy to cause the stone to move to calyx,it can not be used in soft lenses.Since the mid-90s of the 20th century,The same specialist was used holmium laser technology emerged and was used in the treatment of urinary stones.In this article we compare the therapeutic effect and safety of holmium laser lithotripsy(HL) with penumatic lithotripsy(PL) on the treatment of ureteral calculi.[Methods] Clinical data of HL(216 cases) and PL(208cases) was collected from January 2015 to January 2016 and compared with statistical analysis in the stone success rate and complications,in order to know the safty and efficacy of holmium laser lithotripsy.[Results] The average operation time and postoperative hematuria time of HL were shorter than that of PL (31.54±8.21 min vs 43.11±12.10 min, 3.30±1.70days vs 4.18±1.43days). The postoperative hospital stay and complications were shorter for PL (4.74±1.31 days vs. 5.75± 1.51 days,6 cases vs 15cases).In the proximal ureteral calculi patients,stones free rate was 94.7% in HL which is significantly increased compared with 83.6% in PL.In the middle and distal ureteral calculi,there is no significant differences in stones free rate between HL(98.3%) and PL(93.5%).[Conclusion] The ureteroscopy with holmium laser lithotripsy (HL) is an excellent form of treatment for ureteral calculi. It is more reliable, highly effective, rapid and safe procedure than pneumatic lithotripsy(PL).The intraoperative ureteral perforation,avulsion and less postoperative complications of fever, but the incidence of postoperative ureteral stricture above pneumatic ballistic lithotripsy. At present there are conditions and mature technology in the hospital, holmium laser lithotripsy is still the first choice in the treatment of ureteral calculi surgery way, but should pay attention to intraoperative holmium laser for ureteral injury caused by the long-term complications.[Objective] To investigate the causes, diagnosis and treatment, and prognosis of ureteral stricture caused by holmium laser lithotripsy, so as to provide reference for the diagnosis and treatment of ureteral stricture caused by holmium laser.[Methods] During January 2015 to November 2016, the research retrospectively analyzed the clinical data of patients with ureteral stricture caused by holmium laser admitted in the department of Urology in the Second Affiliated Hospital of Kunming Medical University. Different surgical procedures were carried out according to the actual condition of patients. Incorporated patients were followed up and analyzed after collecting the information. Furthermore, clinical effect of different strategies were summarized in the treatment of ureteral stricture caused by holmium laser.[Results] In the 74 cases of ureteral stricture cases.There are 40 males and 44 females.The ages of the patients are from 20 to 68 year,mean age is 43.5 year.In the 74 Unilateral cases.34 are right, 37 are left,3 are all.Clinical manifestations:ipsilateral low back pain manifest in 31 cases;there are 43cases which did not have clinical manifestations are discovered by medical examination.All 74 patients were treated with surgery,there was no occurrence of complications such as perforation of ureter and avulsion in 49 patients underwent ureteroscopic treatment; meanwhile, there was no obvious bleeding during operation, indwelling double J tube was given for 6 months, and the average hospitalization time was about 2 days. In 18 cases of abdominal surgery patients, 3 patients with intraoperative severe adhesion or obvious bleeding were converted to open operation, corresponding operation time was 120-180min (average time of 142min), and intraoperative blood loss of 30-750ml(average bleeding volume of 78ml). No intraoperative or postoperative blood transfusion was performed, without urine leakage postoperatively, postoperative hospitalization time time was 7-10d, and the indwelling double J tube was given for 6 months. All the patients were followed up for 3-6 months after removal of double J tubes except 7 patients with laparoscopic nephrectomy for nonfunctional kidney. Via B-mode ultrasonography of double kidney and ureter as well as intravenous urography, reexamination results indicated that 5 cases showed no remission in stenosis in the treatment group, accompanied with aggravated hydronephrosis compared with the original films, requiring second hospitalization and operation.Remaining 44 cases of patients had obvious improvement in postoperative hydrops,waist pain, fever and other symptoms disappeared. In the laparoscopic and open surgery group, of 18 cases, 1 patient showed recurrent hydronephrosis after removal of ureteral stent, which might be correlated with anastomotic stricture.The effectiveness of laparoscopic and open surgery surgery was 94.5%.[Conclusion] The incidence of induced ureteral stricture increases significantly than before with the wide application of holmium laser in the cavity. B ultrasound can be used as a preliminary inspection measure of ureteral stricture caused by holmium laser.For the evaluation of the location, length and degree of stenosis, further examination such as IVP,CTU,MRU,ureteroscopy,etc. are needed,these inspection results hence provide an important reference for the choice of operative methods. Appropriate treatment options are confirmed according to the condition of renal function, the location, length and degree of the stenosis, accordingly, intracavitary therapy,laparoscopy and open surgery can all effectively relieve ureteral obstruction and achieve better curative effect. |
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