肾结石大小和部位对逆行性软性输尿管镜钬激光碎石手术效果的影响

The efficacy of stone size and location on treatment outcomes of retrograde ureteroscopic holmium laser lithotripsy for renal calculi

目的评价结石大小及部位与逆行性软性输尿管镜钬激光碎石术治疗肾结石的效果的关系。方法回顾性分析从2006年3月至2009年3月在我院行逆行性软性输尿管镜下钬激光碎石术治疗肾结石的资料。结果共180例肾结石患者，年龄18～80岁，平均51岁，其中男性102例，女性78例，经历了216次软性输尿管镜钬激光碎石治疗。结石大小在治疗成功组（11．78±5．10mm）和未成功组（27．50±9．01mm）之间有显著差异（P〈0．01）。结石直径≤20mm的病例治疗成功率为96．2％。位于肾盂（54例）、肾盏憩室（8例）、肾上极（23例）、中极（23例）和下极（108例）的结石排空率分别为87％、87．5％、78．3％、95．7％和94．4％，不同部位的结石排空率无显著性差异（P〉0．05）。结论逆行性软性输尿管镜下钬激光碎石术治疗肾结石安全、有效。处理≤20mm的结石可达到〉90％的排空率，但结石〉20mm时排空率会有所降低。肾结石的位置对治疗效果没有影响。

Objectives To assess the efficacy of stone size and location on treatment outcomes of retrograde ureteroscopic holmium laser lithotripsy for renal calculi. Methods Data concerning patients with renal calculus who were treated with retrograde ureterorenoscopic laser lithotripsy between May 2006 and May 2009 were retrospectively analyzed. Results One hundred and eighty patients had 216 treatments （median = 51 years; range 18 - 80 years）. Overall success rate was 90.7%. The stone size was significant differences between the successful （ 11.78 ± 5.10mm） and nonsuccessful （27.50 ± 9.01 mm） outcome groups （ P 〈 0.01 ）. Of treatments for stone size ≤20mm, 96.2% were successful. Stone locations were： Renal pelvis, caliceal diverticula, and upper pole, midpolar, and lower pole in 54, 8, 23, 23, and 108 cases with success rates of 87%, 87.5%, 78.3%, 95.7% , and 94.4%, respectively （ p 〉 0. 05 ）. Conclusions Retrograde ureteroscopy holmium laser lithotripsy is a safe and effective treatment for renal calculi. Clearance rates of 〉 90% can be achieved for stones up to 20mm, but with larger stones, the stone- free rates reduce significantly. Stone location do not influence outcome.