输尿管软镜钬激光碎石术在马蹄肾结石中的应用

Flexible ureterorenoscopy with holmium laser in the management of stones in the horseshoe kidney(Report of 13 cases)

目的:探讨输尿管软镜钬激光碎石术治疗马蹄肾结石的安全性及有效性。方法:回顾性分析2005年1月～2010年12月采用输尿管软镜钬激光碎石术治疗马蹄肾结石13例患者资料。结石直径平均为1.7(1.2～2.3)cm。主要临床症状为腰痛、尿路感染、血尿。6例患者有ESWL史,2例曾行经皮肾镜取石术。术前1周均留置双J管,均行尿培养、静脉尿路造影及双肾CT检查。术中均先放置输尿管扩张鞘,然后置入输尿管软镜抵达肾盂。术后第1天及2个月复查KUB平片、B超或双肾CT平扫。术后检查无残石或结石残块<3mm视为碎石成功。结果:13例患者均顺利放置镜鞘并置入输尿管软镜,进镜成功率100%。患者碎石成功12例(92.3%)。1例术后结石残块略大于3mm,行ESWL处理。平均手术时间90min,平均住院2d。无手术并发症发生。术后症状均消失。结论:输尿管软镜钬激光碎石术治疗马蹄肾结石是一种可供选择的安全、有效、微创治疗方法。

Objective：To evaluate the therapeutic effect of flexible ureterorenoscopy（F-URS） with holmium laser in treating stones in the horseshoe kidney（HSK）. Method：We retrospectively reviewed the records of 13 patients who underwent F-URS using a holmium laser from January 2005 to December 2010 for HSK stones.The average stone diameter was 1.7 cm（range1.2-2.3 cm）.The presenting symptoms were renal colic,urinary tract infection,or hematuria.F-URS was used in as an alternative after the failure of extracorporeal shock wave lithotripsy in 6 patients and percutaneous nephrolithotomy failure in 2 patients.At one week before operations,all patients was placed the Double-J stent and underwent urinalysis,urine culture,intravenous urography with tomograms,renal computed tomography（CT）.The ureteral access sheaths was placed firstly during operation,and then ureterorenoscope was inserted into the renal pelvis.Follow-up examination was performed after two months with plain radiography of the kidneys,ureters,and bladder and renal ultrasonography,or noncontrast CT.Success was defined as stone-free status or residual fragments 3 mm. Result：Flexible ureterorenoscopes were successfully placed in all patients.The operative success rate was 92.3%.All patients were symptom free after operation.The average operative time and hospital stay were 90 minutes and 2 days,respectively.No severe complications occured. Conclusion：F-URS with the holmium laser is a safe,efficient minimal invasive procedure as a reasonable alternative for treating HSK stones.