组合式输尿管软镜联合钬激光治疗肾结石46例报告

Modular flexible ureteroscope combined with holmium laser lithotripsy for treatment of renal calcu- li ： report of 46 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的安全性和疗效，初步评价组合式输尿管软镜的临床应用价值。方法我院2009年12月至2011年5月采用组合式输尿管软镜下钬激光碎石术治疗的肾结石患者46例，男25例，女21例。年龄22—65岁，平均41岁。结石位于肾中、上盏19例，肾下盏8例，肾盂15例，多肾盏结石4例。结石直径6—31mm，平均15mm，其中结石直径〈10mm组8例，10—20mm组32例，〉20mm组6例。硬膜外麻醉下，采用组合式输尿管软镜寻及结石后使用200μm光纤，0．8—1．0J／15～20Hz（12～20w）功率钬激光碎石。术后常规留置5～6F双J管和导尿管。评估手术时间、出血量及并发症情况。术后4周复查B超或KUB，评估结石排净率。直径≥4mm为有临床意义的残留结石。结果本组46例中，1例因输尿管狭窄，输尿管软镜无法上行至肾盂而改行PCNL；45例进镜顺利，1例下盏结石未寻及，余44例手术时间45～150min，平均110min。结石寻及率95．6％（44／46），一次碎石成功率86．9％（40／46）。肾中、上盏结石碎石成功率为100．0％（19／19），下盏结石碎石成功率75．0％（6／8），肾盂及多肾盏结石碎石成功率为83．3％（15／18）。结石直径〈10mm组一次碎石成功率为100．O％（8／8），10～20mm组为93．7％（30／32），〉20mm组为40．0％（2／5）。无大出血、输尿管穿孑L等并发症。术后第2天拔除导尿管，术后住院2—5d，平均3d。术后4周复查B超或KUB，5例残留结石≥4mm，其中2例结石位于肾下盏，3例位于多个肾盏或肾盂。结论组合式输尿管软镜联合钬激光治疗肾结石安全、疗效满意。

Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser lithotripsy for treatment of renal calculi. Methods A total of 46 patients with renal calculi were treated with modular flexible ureteroscope combined with Ho： YAG litbotripsy in our hospital from December 2009 to May 2011. There were 19 cases in middle and upper calyx, 8 cases in lower calyx, 15 case in renal pelvic, and 4 cases in multiple calyxes. The calculi diameter ranged from 6rnm to 31 mm （average in 15 ±7.9 mm）. Flexible ureteroscope was used to find renal calculus under epidural anesthesia, and Holmium laser lithotripsy was used at a maximum energy of 12 to 20W （0.8 - 1.0 J/15 - 20 Hz）. F5 or F6 double-J tubes and catheters were indwelled routinely postoperatively. -examine with KUB and removethe catheter 2 days after operation. Re-examine with B-ultrasonography or KUB 4 weeks after operation to evaluate the stone free rate. Residual stones 〉 4 mm were regarded as clinical significance of residual stone fragments. Results 45 operations were successful except one case changed to percutaneous nephrolithotomy （PCNL） because of ureteral stricture. The operation time was 45 - 150 min （average in 110.4 ± 25.3 min）. The patients were discharged from hospital in 2 - 5 days（ average in 3 days） after operation. The stone detection rate was 95.6% （44/46）, and the stone free rate was 86.9% （40/46） after one operation. No severe complications such as ureteral perforation or hemorrhea occurred. Conclusions Modular flexible ureteroscope combined with Holmium laser lithotripsy is effective and safe for treatment ofrenal calculi, meanwhile it can decrease the high maintenance costs of integrated flexible ureteroscope.