输尿管软镜钬激光碎石术治疗鹿角形肾结石疗效分析

Flexible ureteroscopy with holmium laser lithotripsy in management of renal staghorn calculi

目的 探讨输尿管软镜钬激光碎石术治疗鹿角形肾结石的效果。方法 对18例鹿角形结石患者,实施全麻下输尿管软镜钬激光碎石术。术后1周复查KUB平片,了解碎石效果及双J管位置。术后4周再次复查KUB平片,评估结石清除率。无碎块残留或残块〈3 mm,视为碎石成功,可拔除双J管。残留结石〉3 mm为有意义的结石残留,需再次行输尿管软镜钬激光碎石术治疗。结果 患者均一次性放置镜鞘并置入输尿管软镜。手术时间60-250 min,术后住院时间5-8 d,单次手术结石清除率为77.8%（14/18）,二次手术结石清除率为94.4%（17/18）。1例患者术后“石街”形成,3周后复查KUB结石排出。术中未发生大出血、输尿管穿孔、输尿管撕脱、术后尿源性脓毒血症等严重并发症。结论 输尿管软镜钬激光碎石术治疗鹿角形肾结石,微创、安全、有效。

Objective To evaluate the efficacy and safety of the flexible ureteroscopy with holmium laser lithotripsy for renal staghorn calculi. Methods Totally 18 cases of renal staghorn calculi were treated with flexible ureteroscopy. Separately re-examination with KUB after operation 1 and 4 weeks is to evaluate the stone free rate and the position of Double-J. Residual stones ﹥3mm are regarded as clinical signifi-cance of residual stone fragments. Results The success rate of the ureteroscopic insertion is 100%. The average operation time is 60-250mins. The average postoperative hospital stay is5-8 d. The stone free rate is 77. 8（14/18）for single procedure and 94. 4%（17/18）for second proce-dure. 1 case appears in form of“steinstrasse”. It is not serious complications such as massive hemorrhea,ureteral perforation,ureteral avulsion or severe infection occurred. Conclusion Flexible ureteroscopy with holmium laser lithotripsy is a safe,effective treatment for renal staghorn calculi.