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題 名 | Application of the Holmium Yttrium-Aluminum-Garnet Laser for Complicated Impacted Ureteral Stones: A Preliminary Report=使用鈥亞鉻雷射流於複雜阻塞性輸尿管結石:初步報告 |
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作 者 | 陳志碩; 陳煜; 朱聖賢; | 書刊名 | 長庚醫學 |
卷 期 | 22:2 1999.06[民88.06] |
頁 次 | 頁259-264 |
分類號 | 416.274 |
關鍵詞 | 鈥亞鉻雷射截石術; 高壓灌流; 阻塞性輸尿管結石; Holmium lasertripsy; High-pressure irrigation; Impacted ureteral stone; |
語 文 | 英文(English) |
中文摘要 | 背景:微創手術在外科領域是一不可避免的趨勢。對體外震波碎石失敗的下輸尿 管結石,內視鏡電擊截石是一廣為採用的方法。本報告是評估雷射在治療較大阻塞性輸尿管 結石的效果與安全性。 方法:在 1998 年 3 月到 4 月的臨床試驗裡,13 個輸尿管結石病 患接受鈥亞鉻雷射截石術的治療, 其中 6 個病患屬較大阻塞性輸尿管結石 (1.3-3.8 公分 )。 我們使用 6.5 Fr. 半硬式輸尿管鏡與 550-nm 微細雷射光纖,在 3 Fr. 輸尿管導管的 引導下,進行雷射截石。為增加內視鏡能見度與促進結石排空,我們將高壓灌流幫浦設定在 300 水銀柱高。結果:這 6 位病患結石的排空率為 100 %。我們沒有任何術中併發症的發 生,甚至在治療一串 3.8 公分的上輸尿管結石時亦然。 所有術前的腎臟水腫都明顯改善或 消失。整體而言,對這類高難度的阻塞性輸尿管結石,雷射截石術不包括麻醉的手術時間約 為 30 分鐘。為增加內視鏡能見度與促進結石排空,所合併使用的高壓灌流,並不會引起術 中與術後病患的腰痛或發燒。結論:鈥亞鉻雷射截石術,對較大阻塞性輸尿管結石是一個極佳 的治療方法。這方法既有效又安全。而且,這治療方法對操作內視鏡純熟的泌尿科醫師而言 ,並不需要特殊的學習曲線。它幫助泌尿科醫師較大阻塞性輸尿管結石,進行微創手術,而非傳 統的開刀手術。 |
英文摘要 | Background:Minimally invasive surgery is a current trend in all kinds of surgical fields. Endoscopic stone manipulation with electrohydraulic lithotripsy (EHL) is the preferred method for treating lower ureteral stones or calculi which cannot be resolved with extracorporeal shock wave lithotripsy (SWL). We evaluated the efficiency and safety of holmium yttrium-aluminum-granet (YAG) laser for treatment of large impacted ureteral stones. Methods:In a clinical trial period including April and May 1998, 13 patients with ureterak stones underwent holmium YAG lasertripsy. Six patients had large impacted ureteral stones (1.3 to 3.8 cm). We conducted lasertripsy with a 6.5-Fr. rigid tapered ureteroscope and a 550-nm SlimLine laser fiber under the guidance of a 3-Fr. ureteral catheter. The irrigation pump was set at 300 mmHg to increase the surgeon's visual clearance and to help keep the operative field ston-free. Results:The postoperative stone-free rate was 100%. There were no intraoperative complications, even in the treatment for a 3.8-cm steinstrasse in the upper ureter. All preoperative hydronephrosis improved. In general, the operative time, not including anesthesia, was less than 30 minutes. There was no intraoperative or postoperative flank pain or fever when the procedure was combined with pressure irrigation for visual clearance and keeping the area stone-free. Conclusion: Holmium YAG lasertripsy is an excellent treatment modality, especially for a large impacted ureteral stone or steinstrasse. The treatment is efficient and safe. Furthermore, there is no learning curve necessary for an experienced endo-urologist. It helps the urologist to carry out a minimally invasive lithotripsy instead of an open surgery for large impacted ureteral stones. |
本系統中英文摘要資訊取自各篇刊載內容。