电子输尿管软镜联合钬激光治疗肾、输尿管上段结石的效果观察

Application effect of electronic flexible ureteroscope combined with holmium laser in the treatment of kidney and upper ureteral calculi

目的:探讨电子输尿管软镜联合钬激光碎石术(FURL)治疗肾、输尿管上段结石的临床效果。方法:回顾性分析采用FURL治疗42例肾、输尿管上段结石患者的临床资料,对患者手术时间、结石清除率、并发症等进行评估。结果:行FURL42例,其中直径≤2 cm结石患者27例,手术时间(73.9±21.2)min,一期结石清除率100.0%;直径>2 cm^3 cm结石患者11例,手术时间(94.5±29.1)min,一期结石清除率81.8%;直径>3 cm结石患者4例,手术时间(120±36.7)min,一期结石清除率25.0%。比较结石直径≤2 cm组和>2 cm^3 cm组患者一期结石清除率,差异无统计学意义(P>0.05),而2组一期结石清除率均高于直径>3 cm组(P<0.01和P<0.05)。尿白细胞阳性组患者出现发热者高于尿白细胞阴性组(P<0.05)。术后有8例出现发热,无其他严重并发症。结论:FURL治疗≤3 cm肾、输尿管上段结石具有微创、安全、高效等优点。

Objective：To evaluate the clinical effects of the electronic fexible ureteroscopy combined with holmium laser lithotripsy （ FURL） in the tretment of kidney and upper ureteral calculi. Methods：The clinical data of 42 kidney and upper ureteral calculi patients treated with FURL were retrospectively analyzed. The operation time,stone-free rate（ SFR） ,and complications were evaluated. Results：A total of 42 patients were treated with FURL. The mean operative duration and first stage SFR in 27 cases with the diameter of calculi ≤2 cm were （73. 9 ± 21. 2）min and 100%,respectively. The mean operative duration and first stage SFR in 11 cases with the diameter of calculi 〉2 cm and ≤3 cm were （94. 5 ± 29. 1）min and 81. 8%,respectively. The mean operative duration and first stage SFR in 4 cases with the diameter of calculi 〉3 cm were （120 ±36. 7） min and 25. 0%,respectively. The difference of the first stage SFR between the patients with the diameter of calculi ≤2 cm,and 〉2 cm and ≤3 cm was not statistically significant（P〉0. 05）, while the first stage SFRs of whose were higher than that in patients with the diameter of calculi 〉3 cm（P〈0. 01 and P〈0. 05）. The number of fever patients in positive urine leukocyte group were higher than that in negative urine leukocyte group. The fever in 8 patients and no other serious complications were found. Conclusions：The treatment of kidney and upper ureteral calculi with the diameter ≤2 cm with FURL is minimally invasive,safe and effective.