输尿管硬镜联合软镜钬激光治疗肾盂2-3cm结石42例报告

Combined Use of Rigid and Flexible Ureteroscopic Holium Laser Lithotripsy in the Treatment of Renal Pelvis Stones Sized 2- 3 cm: a Report of 42 Cases

目的探讨输尿管硬镜辅以软镜钬激光碎石治疗2-3 cm肾盂结石的疗效和安全性。方法 2010年6月-2014年6月,采用经尿道输尿管硬镜钬激光碎石或同期辅以输尿管软镜钬激光碎石治疗2-3 cm肾盂结石42例,对〉6 mm残石给予分期ESWL、再次输尿管软镜或输尿管硬镜联合微创经皮肾镜取石治疗。结果输尿管硬镜钬激光成功碎石9例,辅以输尿管软镜钬激光成功碎石19例,术后1次ESWL、2次ESWL、输尿管软镜碎石、输尿管镜联合微创经皮肾镜取石成功碎石分别为6例、2例、2例和1例,本组总碎石成功率为92.9%（39/42）。2例≤6 mm残石给予药物治疗,1例进镜失败改为开放手术治愈。术后均有不同程度肉眼血尿,体温〉38℃7例,无输尿管穿孔、大出血、脓肾等严重并发症发生。结论输尿管硬镜钬激光碎石或辅以输尿管软镜钬激光碎石治疗2-3 cm肾盂结石安全、有效。术后联合ESWL可以获得较理想的碎石效果。

Objective To discuss the effectiveness and safety of combined use of rigid and flexible ureteroscopy to treat renal pelvis stone by using Holium laser. Methods From June 2010 to June 2014, a total of 42 cases of renal pelvis stones, sized 2 -3 cm, were given Holium laser litbotripsy by rigid and flexible ureteroscopy. Secondary ESWL and flexible and rigid ureteroseopy with mPCNL were used for patients with residual stones 〉 6 ram. Results Nine cases had once successful laser lithotripsy by rigid ureteroscopy. Other 19 successful cases bad adjuvant flexible ureteroscopy. The successful litbotripsy combined with once or twice ESWL, flexible ureteroscopy, and mPCNL with URL at postoperation were in 6, 2, 2, and 1 cases, respectively. The total success rate was 92.9% （39/42）. Two cases of residual stones 〈 6 mm were given medicine treatment. Failed of inserting ureteroscopy was encountered in 1 case. Varying degrees of gross hematuria appeared in all cases. Seven cases had a fever higher than 38℃. No severe complications such as ureter perforation, severe bleeding, or pyonepbrosis occurred. Conclusions It is safe and effective to utilized Holium laser to treat 2 - 3 cm renal pelvis calculus with rigid and adjuvant flexible uretheroscopy. Combined use of ESWL is effective when necessary.