目的 总结输尿管镜下钬激光诊治输尿管阴性结石的体会.方法 经B超和静脉尿路造影(IVU)和CT检查确诊输尿管阴性结石81例.在输尿管硬镜或辅以输尿管软镜下行钬激光碎石.结果 81例中,56例输尿管中下段结石均一次成功碎石；25例输尿管上段结石中13例预置N-Trap网篮也一次碎石成功.另12例输尿管镜直接碎石中8例有碎石(＞5 mm)被冲入肾盂,继用输尿管软镜碎石,其中2例肾下盏内残留5～6 mm结石给予随访无变化,总的碎石成功率为97.5％(79/81).术中未见输尿管穿孔、黏膜撕脱等严重并发症,术后均有不同程度肉眼血尿,经术后1～3 d血尿自然消失.结论 B超结合IVU或CT对输尿管阴性结石是一种价廉、安全、有效的诊断工具.输尿管镜下钬激光治疗输尿管阴性结石安全有效,并发症少.术前预置N-Trap网篮可提高输尿管上段结石一次碎石成功率.%Objective To summarize the experience with the treatment of radioparent ureteral calculi by ureteroscopic holmium laser lithotripsy.Methods Holmium laser lithotripsy was performed under ureteroscope or flexible ureteroscope in 81 patients with radioparent ureteral calculi confirmed by B-mode ultrasonography,intravenous urography (IVU) and CT scan.Results Among the 81 patients,middle and lower ureteral stones were successfully fragmented at the first attempt in 56 patients,as well as in 13 upper ureteral stone patients with preset N-Trap basket.Among the other 12 patients who underwent ureteroscopic lithotripsy,8 received lithotripsy under flexible ureteroscope due to the fragments (＞5 mm) were propelled into renal pelvis,and 2 had residual stones (5-6 mm) in renal pelvis after follow-up.The overall stone-free rate was 97.5％(79/81).No serious complications such as ureteral perforation and avulsion were observed.Different levels of gross hematuria occurred,but disappeared 1-3 days after operation.Conclusion B-mode ultrasonography combined with IVU or CT is economical,safe and effective for the diagnosis of radioparent ureteral calculi.Ureteroscopic holmium laser lithotripsy can safely and effectively treat radioparent ureteral calculi with fewer complications.The preset N-Trap basket can improve the success rate of the first treatment of upper ureteral stones.
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