同期双侧输尿管软镜钬激光碎石术安全性及疗效分析

Simultaneous bilateral flexible ureteroscopy with holmium laser lithotripsy:analysis of safety and efficacy

目的评价输尿管软镜钬激光碎石术同期治疗双侧上尿路结石的安全性和有效性。方法回顾性分析2004年1月至2013年2月采用输尿管软镜钬激光碎石术同期治疗双侧上尿路结石78例患者（156例患肾）的临床资料，男51例、女27例，年龄22～74（43±12）岁，患者结石数2～5（3．0±0．5）个，累计结石最大径1．0～5．0（2．5±1.2）cm。患者静脉复合麻醉下行同期双侧输尿管软镜钬激光碎石术，如伴有输尿管上段结石先行输尿管硬镜钬激光碎石，留置输尿管软镜输送鞘，置入输尿管软镜抵达肾盂，予以钬激光碎石，较大碎块用取石套篮抓出。术后检查无残石或残留结石直径〈4mm视为碎石成功。统计分析手术时间、结石清除率及并发症发生情况。结果本组78例患者均顺利置入双侧输尿管软镜，单次手术时间40～312（74．0±40．4）min。术中无大出血，输尿管穿孔、撕脱和断裂等并发症发生。碎石成功率为93．6％（146／156），结石清除率为86．0％（134／156），7例（9．0％，7／78）患者因结石负荷过大接受了第2次输尿管软镜碎石术。术后单纯性发热（体温〉38℃）发生率为2．6％（2／78）。结论同期双侧输尿管软镜碎石术疗效显著、安全性高，是处理双侧上尿路结石的可靠治疗方案。

Objective To discuss the safety and efficacy of simultaneous bilateral flexible ureteroscopy （SBFU） with holmium laser lithotripsy for bilateral renal or ureteral calculi. Methods The clinical data of 78 patients （51 males, 27 females; average age [43±12] years, range 22 to 74 years） who underwent SBFU with holmium laser lithotripsy for bilateral renal or ureteral calculi in our hospital between January 2004 and February 2013 were retrospectively reviewed. The mean number of stones per case was 3.0±0.5 （range 2 to 5）, and the mean diameter of the largest stone was （2.5±1.2） cm （range 1.0 to 5.0 cm）. The operation was conducted under intravenous anesthesia. The upper ureteral calculi was removed firstly by ureteroscopy with holmium laser when it existed. After the ureteral access sheath was placed, flexible ureteroscopy was inserted into the renal pelvis, and then a 200μm holmium laser fiber was used for fragmentizing stones and the large pieces was removed by stone basket. The operation was considered successful if no residual stone existed or residual stones were less than 4 mm in diameter during postoperative examination. Clinical data including operation time, stone-free rate and complications were analyzed. Results The flexible ureteroscopy was successfully placed in all the 78 cases, and the average operation time per ease was （74.0±40.4） min （range 40 to 312 min）, with no bleeding, ureteral perforation, avulsion or rupture during operation. The success rate of stone fragmentation was 93. 6%（146/156） and the stone-free rate was 86.0% （134/156）. Seven cases （9.0 %, 7/78） required a second stage flexible ureteroscopy with holmium laser lithotripsy. The postoperative fever （〉38℃） was found in 2 cases （2. 6%, 2/78）. Conclusion SBFU with holmium laser lithotripsy is a safe and effective treatment for bilateral renal or ureteral calculi. This procedure is a reliable treatment option for bilateral renal or ureteral calculi.