输尿管软镜治疗开放手术残余结石

Flexible ureteroscope in the treatment of residual calculus after open surgery

目的观察输尿管软镜治疗开放手术后残余结石的临床效果,探讨输尿管软镜在治疗术后残余结石中的应用价值。方法选取我院2010年6月~2011年10月收治的106例开放手术治疗肾、输尿管结石后残余结石患者作为研究对象,所有患者均采用输尿管软镜钬激光碎石联合套石篮取石术,按照结石直径大小分为两组,A组（结石直径〈8 mm）和B组（结石直径≥8 mm）,观察比较两组残余结石排出效果及并发症情况。结果两组患者手术时间、术后住院天数、结石排净时间及并发症情况差异均无统计学意义（P〉0.05）。A组56例患者单次碎石成功47例,单次碎石成功率为83.9%,其余9例患者行再次碎石后均成功,总成功率为100.0%;B组50例患者单次碎石成功36例,单次碎石成功率为72.0%,其余14例患者行再次碎石后均成功,总成功率为100.0%,两组患者单次碎石成功率差异有高度统计学意义（P〈0.01）,但总成功率差异无统计学意义（P〉0.05）,且两组均无并发症发生。结论输尿管软镜治疗开放手术后残余结石效果理想,具有安全性高的特点,尤其适合结石直径小的患者,值得推广应用。

Objective To observe the clinical effects of flexible ureteroscope in the treatment of residual calculus after open surgery,and to explore the value of flexible ureteroscope in the treatment of postoperative residual calculus.Methods 106 cases of patients with residual calculus after open surgical treatment of kidney stones and ureteral calculus were selected as the objects of the study in our hospital from June 2010 to October 2011.All patients were treated with flexible ureteroscope holmium laser lithotripsy combined with stone basket lithotripsy.According to calculus diameters,all patients were divided into two groups,group A（calculus diameters 8 mm） and group B（calculus diameters ≥ 8 mm）.The discharged effects of residual calculus and complication of the two groups were observed and compared.Results There were no significant differences between the two groups in operative time,postoperative hospital stay,calculus drain time and complications（P 0.05）.Among 56 patients of group A,47 cases were successful in crushing calculus in the first surgery,the success rate was 83.9%,and the other 9 patients were successful in crushing calculus in the second surgery,the total success rate was 100.0%.Among 50 patients of group B,36 cases were successful in crushing calculus in the first surgery,the success rate was 72.0%,and the other 14 patients were successful in crushing calculus in the second surgery,the total success rate was 100.0%.The success rate of single crushing calculus surgery was significant difference between the two groups（P 0.01）,but the total success rate had no difference,and both of the two group had no complications.Conclusion The effect of flexible ureteroscope in the treatment of residual calculus after open surgery is satisfactory.Flexible ureteroscope has high security feature,which is particularly suitable for patients with small diameter calculus.It is worthy of widely application.