组合式输尿管软镜联合钬激光治疗肾及输尿管上段结石97例报告

Modular Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy for Renal and Upper Ureteral Stones: Report of 97 Cases

目的：探讨组合式输尿管软镜下钬激光碎石术治疗肾结石及上段输尿管结石的疗效。方法我院2012年10月～2016年2月采用组合式输尿管软镜下钬激光碎石术治疗肾及输尿管上段结石97例，7例硬腰联合麻醉，90例采用静脉全麻，组合式输尿管软镜寻及结石后使用220μm光纤，1．2～1．6 J／10～12 Hz（12～20 W）功率钬激光碎石。术后常规留置F6～7双J管和导尿管。术后4周复查B超或KUB或CT，评估清石率。结果2例因输尿管狭窄迂曲，发生输尿管穿孔，输尿管硬镜下留置双J管2周再次行软镜治疗；6例因输尿管狭窄，先置入输尿管支架管2周后二期行软镜碎石；其余89例进镜顺利。3例下盏结石未寻及，余94例手术时间30～190 min，平均100 min。结石寻及率96．9%（94／97），一次碎石成功率88.6%（86／97）。肾中、上盏结石碎石成功率100．0%（25／25），下盏结石碎石成功率75．0%（9／12），肾盂及多肾盏结石碎石成功率85．1%（23／27）。输尿管穿孔2例，无大出血并发症；术后高热5例，体温38．5～39．3℃，经抗感染治疗2～7 d体温恢复正常。术后住院2～7 d，平均3．3 d。术后4周复查B超或KUB或CT，5例残留结石＞4 mm，其中3例结石位于肾下盏，2例位于多个肾盏。结论组合式输尿管软镜联合钬激光治疗肾及输尿管上段结石疗效满意。

Objective To evaluate the efficacy of modular flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of renal and upper ureteral stones . Methods A total of 97 patients with renal and upper ureteral stones were treated with modular flexible ureteroscopy combined with holmium laser lithotripsy in our hospital from October 2012 to February 2016.Under general anesthesia （90 cases） or epidural anesthesia （7 cases）, a flexible ureteroscope was used to find renal or ureteral calculus and holmium laser lithotripsy was applied at a maximum energy of 1.2-1.6 J/10 -12 Hz （12-20 W）.F6 or F7 double-J stents and catheters were routinely placed postoperatively .B-ultrasonography , KUB or CT were performed to evaluate the stone free rate 4 weeks after operation . Results Two patients suffered ureteral perforation due to stenosis and tortuosity of the ureter , and were given double-J stent placement under rigid ureteroscopy for 2 weeks and then flexible ureteroscopic treatment .Six patients underwent staged operations because of ureteral strictures .The operations were successful in the remaining 89 patients.Except for unsuccessful exploration in 3 cases of lower calyx calculi , the operation time of other 94 patients was 30-190 min （mean, 100 min）.The stone detection rate was 96.9%（94/97）, and the stone free rate was 88.6% （86/97）.The stone free rates were 100.0% （25/25） for upper and middle calyx calculi, 75.0%（9/12） for lower calyx calculi, and 85.1% （23/27） for pelvis and multiple calyx calculi. Ureteral perforation was encountered in 2 cases.No massive hemorrhage occurred .Postoperative high fever was seen in 5 cases, with a body temperature of 38.5-39.3℃, which were cured after anti-infection treatment for 2 -7 d.The patients were discharged from hospital in 2-7 days （mean, 3.3 days） after operation.Review with B-ultrasonography, KUB or CT at 4 weeks after operation found 5 cases of residual stones 〉4 mm, including 3 cases located in lower calyx and 2 cases in multiple calyx . Conclusion Modular flexible ureteroscopy combined with holmium laser lithotripsy is effective and safe for the treatment of renal calculi .