输尿管软镜处理肾结石术后结石残留的原因分析

Cause Analysis of Residual Stones after Flexible Ureteroscopy for Renal Calculi

目的：探讨输尿管软镜处理肾结石术后结石残留的原因。方法2010年1月～2013年12月，采用输尿管软镜处理肾结石215例，其中术后结石残留32例，分析影响疗效的因素。结果32例结石残留原因中肾盂肾盏夹角＜30°17例，结石脓苔包裹3例，术中未找到结石2例，肾盏颈细长2例，5例因结石负荷较大引起输尿管石街，其余3例考虑多因素引起。术后结石分析提示草酸钙结石22例，胱氨酸结石3例，一水草酸钙与碳酸磷灰石混合结石5例，尿酸结石2例。结论结石残留主要影响因素有肾盂肾盏结构、结石负荷、结石成分及结石有无脓苔包裹。选取适宜的肾结石患者，术中针对可能造成排石困难的各种不利因素采取相应措施，是提高输尿管软镜碎石术结石清除率的关键。

Objective To investigate the cause of residual stones after flexible ureteroscopy for renal calculi. Methods We retrospectively assessed 215 cases of renal calculi treated by flexible ureteroscopic lithotripsy between January 2010 and December 2013,and analyzed 32 cases of residual stones after operation. Results Among the 32 cases,the angle of renal pelvis and calyces was less than 30°in 17 cases,stones were covered by pus in 3 cases,stones were unable to find in 2 cases,tenuous calyx neck existed in 2 cases,overburdened stones caused ureter stone-street in 5 cases,and the left 3 cases were caused by multiple factors.The stone analysis showed calcium oxalate stones （22 cases）,cystine stones （3 cases）,calcium oxalate monohydrate mixed with carbonate apatite stones （5 cases）and uric acid stone （2 cases）,respectively. Conclusions The main factors of residual stones include the structure of renal pelvis and calyces,stone size,stone compositions,and stones covered by pus or not.The key to improve the stone free rate of flexible ureteroscopic lithotripsy is choosing appropriate patients and taking appropriate measures to handle the various adverse factors mentioned above.