特殊类型肾结石应用输尿管软镜治疗的临床评估

Clinical evaluation of flexible ureteroscopy in the treatment of special renal caculi

目的:探讨输尿管软镜钬激光碎石术(flexible ureteroscopy combined holmium laser lithotripsy,f-URS)治疗特殊类型肾结石的有效性和安全性。方法:回顾分析我院2014年1月至2015年8月收治的经f-URS治疗的22例特殊类型肾结石患者,包括过度肥胖2例,脊柱侧弯1例,盆腔异位肾1例,不完全输尿管畸形2例,肾盏憩室5例,独肾10例,马蹄肾2例。结石单发12例,多发10例。结石平均大小为(1.50±0.82)cm。术前10例尿常规白细胞计数>500个/μL,6例合并肾功能不全。结果:21例术中成功探及结石并粉碎,1例马蹄肾患者术中软镜无法粉碎到全部结石。平均碎石次数1.3次,平均手术时间(66±24)min,平均术后住院时间(1.73±1.15)d。1例术后发热,静脉应用抗生素后治愈。术后4周复查3例结石残留,肾功能不全均有改善。结论:输尿管软镜钬激光碎石术治疗特殊类型肾结石有效、安全。

Objective：To evaluate the effectiveness and safety of flexible ureteroscopy combined holmium laser lithotripsy（f-URS）in the treatment of special renal calculi. Methods：A total of 22 special patients with renal calculi who were treated by f-URS from January 2014 to August 2015 were reviewed,including 2 cases of obesity,1 case of scoliosis,1 case of renal pelvic ectopia,2 cases of incomplete ureteral duplication,5 cases of calyceal diverticulum,10 cases of isolated kidney and 2 cases of horseshoe kidney. Twelve patients were single stone and 10 patients were multiple stones. Average stone size was（1.50±0.82）cm. Ten patients had a urinary leukocyte count of 500 cells/μL in routine urinalysis and 6 patients had renal insufficiency before f-URS. Results：All stones were detected and smashed successfully in 21 patients but a bit of stones can not be detected in one patient with horseshoe kidney. The average operation number,time and postoperative hospital days were 1.3 times,（66±24）min and（1.73±1.15）days,respectively.One patient had a fever after f-URS and was cured by intravenous antibiotics therapy. Three patients were not stone free and patients with renal insufficiency had renal function improved. Conclusion：f-URS is an effective and safe choice for special renal calculi.