输尿管软镜钬激光碎石取石术应用于>2 cm上尿路结石的临床疗效和安全性

Clinical efficacy and safety of ureteroscopic holmium: YAG laser lithotripsy in the treatment of upper urinary tract stones larger than 2 cm

目的探讨输尿管软镜钬激光碎石取出术应用于治疗>2 cm上尿路结石的临床效果和安全性。方法2014年1月~2017年1月收治的上尿路结石并行输尿管软镜钬激光碎石取出术治疗的病人102例,分析病人年龄、性别、结石大小、部位、碎石时间、结石清除、并发症等临床资料,总结分析手术有效性和安全性。结果102例病人结石平均累计最大径线(CSD)(34.1±9.8)mm;平均碎石时间(28.56±20.45)分钟;平均手术时间(44.18±20.45)分钟;平均住院时间(7.2±2.4)天;102例病人中11例术后发生并发症,占10.78%,包括发热、腰痛、血尿、石街等,未见脓毒血症、感染性休克等严重并发症。多因素回归分析显示,病人术后结石清除率度的独立影响因素为肾积水,术后并发症发生危险因素为手术时间(P<0.05)。结论将输尿管软镜钬激光碎石取出术应用于临床直径大于2 cm的上尿路结石病人,临床安全性高;手术结石清除率与肾积水有关,手术时间长短是影响病人术后并发症发生的一种危险因素。

Objective To study the Clinical efficacy and safety of ureteroscopic holmium:YAG laser lithotripsy in the treatment of upper urinary tract stones larger than 2 cm.Methods A total of 102 cases from January 2014 to January 2017 of upper urinary tract calculi treated with ureteroscopic holmium:YAG laser lithotripsy were included in the study.Analyze the clinical data of patients with age,sex,size,location,time of lithotripsy,stone removal and complications were retrospectively,and summarize the effectiveness and safety of operation.Results The mean cumulative maximum diameter of calculi is(28.56±20.45)min,the mean operative time is(44.18±20.45)min,the average hospitalization time is(7.2±2.4)days,the mean lithotripsy time is(28.56±20.45)min,and the mean length of hospitalization is(7.2±2.4)days.Complications occurred in 11 of 102 patients(10.78%),including fever,low back pain,hematuria,stone street and so on;There were no serious complications such as sepsis and septic shock.Multivariate regression analysis showed that hydronephrosis was the independent influencing factor of stone clearance rate and operative time was the risk factor for postoperative complications(P<0.05).Conclusion The application of ureteroscopic holmium:YAG laser lithotripsy in the treatment of upper urinary tract calculi with clinical diameter larger than 2 cm has high clinical safety.The rate of stone clearance is related to hydronephrosis,and the duration of operation is a risk factor for postoperative complications.