输尿管软镜联合钬激光治疗肾结石的临床疗效分析

Therapeutic Effect of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Renal Calculi

目的探讨应用输尿管软镜联合钬激光治疗肾结石的临床疗效。方法回顾性分析2012年8月-2014年2月应用输尿管软镜联合钬激光碎石治疗的78例肾结石患者的临床资料,结石位于肾中上盏41例,下盏27例,肾盂6例,多肾盏结石4例;结石直径0.8-2.0 cm,平均1.4 cm。软镜进入肾盂及肾脏各盏,寻及结石后使用直径200μm钬激光光导纤维碎石。术后4周复查双肾CT,评估结石清除率。结果 78例肾结石患者经输尿管软镜寻及结石76例,成功率97.4%;一次性碎石成功率94.9%（74/78）;总体结石清除率为97.4%（74/76）。肾结石的手术时间为20-55 min,平均30 min;住院时间2-6 d,平均3 d。术后2例出现发热并腰痛,均经抗感染治疗后痊愈。术后肉眼血尿1-2 d内消失。74例术后随访4-16个月,中位随访时间8个月,均无结石复发。结论输尿管软镜联合钬激光是治疗肾结石的一种安全有效的微创手段,其结石寻及率、碎石成功率、结石清除率高,并发症发生率低,住院时间短,以及可持续治疗。

Objective To evaluate the therapeutic efficacy of flexible ureteroscopic holmium laser combined with lithotripsy in treating renal calculi.Methods We retrospectively analyzed the data of 78 patients from August 2012 to February 2014 who underwent flexible ureteroscopic holmium laser lithotripsy in our hospital.Among them,calculi were located at the upper or middle calyx in 41 patients,at the lower calyx in 27,at the renal pelvis in 6,and at multiple calyxes in 4.The diameter of the stones ranged from 0.8 to 2.0 cm with a mean of 1.4 cm.The stones were fragmentized by using200 μm holmium laser fiber.A follow-up by renal CT scan was done 4 weeks after the procedure to evaluate the rate of the stone clearance.Results The calculi were detected in 76 patients（97.4%,76 / 78）.The success rate in one-session procedure was 94.9%（74 / 78）.After 4 weeks,the total stone-free rate was 97.4%（74 / 76）.The mean operative time was30 minutes（20-55 minutes）.The mean hospital stay of the patients was 3 days（2-6 days）.Two cases were found to have lower back pain combined with fever and cured by anti-inflammatory treatment.Naked eye hematuria disappeared in our cases after operation for 1 to 2 days.Seventy-four cases were followed up from 4 to 16 months with a median time of8 months and no recurrence was detected.Conclusion The flexible ureteroscopic holmium laser lithotripsy is a safe and effective mini-invasive therapy for patients with renal calculi,with a high discovery rate of stones,high success rate,high evacuation rate,few severe complications,short hospital stay and sustainable treatment.