输尿管软镜钬激光碎石治疗孤立肾肾结石的临床疗效观察

Clinic Efficacy of Flexible Ureteroscopy Combined with Holmium Laser Lithotripsy in Treating Solitary Kidney Calculi

目的 探讨输尿管软镜钬激光碎石术治疗孤立肾肾结石的安全性及有效性.方法 邵逸夫医院在2011年5月至2014年12月期间使用输尿管软镜钬激光碎石术共治疗14例孤立肾肾结石患者,男8例,女6例;年龄29～ 75岁,平均54岁.其中,2例为对侧肾切除术后,12例为对侧肾萎缩.术前常规留置F6D-J管2周.分析手术时间、清石率、出血量、术后住院天数、并发症以及血清肌酐的变化.结果 本组14例患者均成功将输尿管鞘放置输尿管上段,输尿管镜鞘放置成功率100％,进镜成功率100％,术中寻找结石成功率100％.14例患者结石大小为1.1 ～2.5cm,平均（1.7±0.4）cm;术前肌酐78 ～ 407 μmol/L,平均（166±103）μmol/L;手术时间60～140分钟,平均（87±34）分钟;术中出血量5～ 50ml,平均（13±12）ml;一期结石清除率达82.6％ （12/14）,2例行二次输尿管软镜手术,总结石清除率达92.8％ （13/14）,2例术后出现发热.14例患者术后肌酐为85～340μmol/L,平均（124±62） μmol/L,与术前比较差异有统计学意义（P＜0.05）.术后住院天数2～4天,平均（2.5±0.7）天.结论 输尿管软镜钬激光碎石术治疗孤立肾肾结石是安全有效的.

Objective To evaluate the safety and therapeutic effect of flexible ureteroscopy combined with lmium laser lithotripsy in treating solitary kidney calculi. Methods From May 2011 to December 2014,14 pa-nts with solitary kidney calculi after flexible ureteroscopy with holmium laser lithotripsy in Sir Run Run Shao spital were reviewed. There were eight male and six female patients and the mean age was 54 years （ ranged -75years） . F6 D -J tube was inserted in all patients to dilate the ureter for 2 weeks preoperatively. Factors h as operation time, stone - free rate （SFR） , intraoperative blood loss, postoperative hospital stay, compli-ions and changes in serum creatinine were analyzed. Results The insertion of flexible ureteroscopy was suc-cessful in all patients. The searching of stone was successful in all patients. The mean stone size was 1.7cm （ranged 1. 1 -2. 5cm） . The mean operation time was 87 minutes （ ranged 60 -140 minutes） . The mean intrao-perative blood loss was 13ml （ ranged 5 -50ml） . The SFR was 82. 6 % （12/14） . Two patients received flexible ureteroscopy twice. The total SFR was 92. 8 % （13/14） ; two patients had fever and were cured after treatment. Postoperative serum creatinine was decreased compared to preoperative serum creatinine which had statistical difference （P 〈0.05 ） . The mean postoperative hospital stay was 2.5 days （ ranged 2 -4 days） . Conclusions Flexible ureteroscopy combined Holmium laser lithotripsy is safe and effective method for solitary kidney calculi.