Experience of Pulsed-Dye Laser Lithotripsy for Ureteral Stones at Tsgh

使用脈衝式染料雷射碎石術治療輸尿管結石之經驗

劉清雄(Ching-Shyong Liu) ； 于大雄(Dah-Shyong Yu) ； 蔡永成(Yung-Cheng Tsai) ； 李祥生(Shang-Sen Lee) ； 孫光煥(Guang-Huan Sun) ； 程千里(Chen-Li Cheng) ； Heiao-Hsien Wang ； 馮超傑(Chau-Jye Fong) ； 楊泰和(Tai-Hou Yang) ； 馬正平(Cheng-Ping Ma)

《Journal of Medical Sciences》 17卷2期 (1996/10) Pp. 131-135

摘要

三軍總醫院自1994年3月至12月使用染料雷射碎石機治療的43位輸尿管結石病人，共有50個結石單位，其中男性27位、女性16位，病人年齡從17歲至82歲（平均年齡45歲），結石平均大小為0.8公分，其中位於上段輸尿管結石有12個，中段輸尿管結石9個，下段輸尿管結石29個；左側輸尿管結石21個，右側輸尿管結石29個。我們使用7.0F直徑的輸尿管鏡不需要先把輸尿管開口擴張即可進入輸尿管腔內。每次碎石使用的震波能量為30至80毫焦耳，平均震波次數為150次，有38例（88%）結石完全擊碎，平均住院天數4天。而5例雷射治療失敗的結石中，有2例是由於輸尿管鏡無法進入結石區，1例是由於結石被水逆衝回腎孟內，2例是由於結石太大而無法完全擊碎。在所有使用雷射治療的病人中沒有發現明顯的輸尿管受傷或穿孔併發症。因此我們認為對於那些體外震波碎石術治療輸尿管結石失敗，或下段輸尿管結石的病例，脈衝式染料雷射碎石術是一種安全而且有效的方法。

關鍵字

脈衝式染料雷射碎石術 ； 輸尿管結石

並列摘要

Between March and December 1994, 43 patients (27 males, 16 females) with 50 ureteral stones were treated endoscopically by Candela pulsed-dye laser lithotripter at our hospital. Their age ranged from 17 to 82 years (mean 45). Stones were 8 mm in average sizes in their longitudinal diameter and situated in the upper ureter in 12, milled ureter in 9, and lower ureter in 29 cases. There were 21 left ureteral stones and 29 right ureteral stones. The 7.0 F miniscope was inserted into the ureter without prior dilatation of ureteral orifice. Stone fragmentation was performed using the dye laser in 30 to 80 mJ energy with pulses of 150. Complete fragmentation of the stones was achieved in 38 patients (88%). The average hospital day was 4 days. Of the 5 unsuccessful cases, 2 were due to impassable ureteroscopy, 1 due to stone migration up to the kidney, and 2 due to large stone burden. No significant morbidity such as perforation or obvious urine extravasation occurred.In conclusion, in ESWL failure, obstructed or lower ureteral stones, the laser lithotripsy is more safe and effective than conventional EHL and ultrasonic lithotripsy.

並列關鍵字

Pulsed-dye laser lithotripsy ； Ureteral stone