输尿管软镜在髓质海绵肾结石治疗中的应用

Application of flexible ureteroscopic lithotripsy in treatment of medullary sponge kidney stones

目的：探讨输尿管软镜钬激光碎石术治疗髓质海绵肾结石的临床疗效与安全性。方法经输尿管输送鞘（ UAS）置入软镜至各肾盏，镜下找到结石所在部位，采用钬激光切开乳头黏膜，然后粉碎结石，冲洗或取出结石碎片。术后观察患者临床症状缓解及术中术后并发症等情况，复查尿路平片。结果14例患者均发现结石并行碎石处理，切开黏膜及乳头管未导致大出血，部分患者腰疼症状在术后3~7d内或拔除双J管后缓解，大部分结石碎片自行排出，术后3个月复查，多数患者结石数量明显减少。结论输尿管软镜下钬激光碎石技术治疗髓质海绵肾结石效果良好，可显著减轻患者结石负荷，术中术后无严重并发症，微创、有效、安全，值得临床推广应用。

Objective To investigate the clinical efficacy and safety of flexible ureteroscopic lithotripsy （ FURL） using holmium laser for medullary sponge kidney stones. Methods A flexible ureteroscope was placed into renal calyx via a ureteral access sheath （ UAS） . The stones underlying the mucosa were found,and then broken by holmium laser following incision of renal papillary mucosa. The stone fragments were washed or clamped out. The remission of clinical symptoms and incidence of perioperative complications were observed,and a KUB plain film was rechecked postoperatively. Results Stones underlying mucosa were found and broken successfully in all 14 patients and there was no serious bleeding. Back pain symptoms of patients were relieved in 3 to 7 days postoperatively or after the removal of double J stent. The stone fragments were mainly discharged spontaneously. The rechecking KUB showed the amount of stones of most patients was significantly re-duced three months after operation. Conclusion FURL using holmium laser is effective for the treatment of medullary sponge kidney stones as it can significantly reduce the loads of stones without serious complications. It’ s a minimally invasive,effective,safe and suitable way which is suitable for further spread of clinical application.