组合式输尿管软镜治疗孤立肾输尿管上段结石

Treatment for upper ureteral calculi of solitary kideny with Holmium laser lithotripsy through modular flexible ureteroscope

目的：探讨使用F8组合式输尿管软镜联合钬激光处理孤立肾输尿管上段结石的临床价值。方法孤立肾输尿管上段结石患者26例,其中左侧结石12例,右侧结石14例。结石直径0.6-2.2cm,平均直径为（1.38±0.22）cm。采用F8“铂立”输尿管软镜联合钬激光进行碎石。术后常规留置F6D-J管4周,留置导尿1周。术后1d查腹部平片（KUB）。结果23例一次顺利置入输尿管导引鞘,2例留置D-J管2周后二次软镜碎石成功,1例D-J管头端未越过结石,仍无法逆行输尿管软镜碎石,改经皮肾通道顺行输尿管软镜碎石成功。一次碎石成功率88.5%（23/26）,二次碎石成功率100%（26/26）。手术时间15-45min平均（27±3.2）min。术中输尿管穿孔1例,术后感染1例。结论采用F8组合式输尿管软镜处理孤立肾输尿管上段结石安全、微创、有效,可作为治疗孤立肾输尿管上段结石的首选方式。

Objective To evaluate the efficiency and clinical value of modular flexible ureteroscope combined with Holmium laser litho-tripsy on the treatment for upper ureteral calculi of solitary kiden. Methods There were 26 cases of upper ureteral calculi of solitary kidney, including 12 cases of left ureter calculi and 14 cases of right ureter calculi. The diameter of the calculi ranged from 0. 6-2. 2 cm, averagely （1. 38 ± 0. 22） cm. F6 double-J tubes were indwelled postoperatively for 4 weeks, and catheters were indwelled postoperatively for one week. Examine with KUB one day after operation to evaluate the effective rate. Results The Ureteral guiding sheath were successfully implanted in 23 cases, 2 cases underwent second lithotripsy after indwelling D-J tubes 2 weeks later, D-J tubes failed to be implanted only in one case, which has changed to percutaneous nephrolithotomy （PCNL） for ureter stricture. The stone free rates was 88. 5%（23/26）after the first ses-sion,and it was 100%（26/26）at the end of the session. The operation time was 15~45 min, meanly （27 ± 3. 2） min. One patient had ureter perforation during the operation, and one patient had severe infection after operation. Conclusion The modular flexible ureteroscopy com-bined with Holmium laser lithotripsy is an effective and safe treatment, especially for upper ureteral calculi of solitary kideny, and it should be considered as the first choice for solitary kidney calculi.