电子输尿管软镜钬激光碎石术在人免疫缺陷病毒感染肾结石患者治疗中的应用

Application of flexible ureteroscopy combined with Holmium laser lithotripsy for kidney calculi patients with HIV positive

目的 评价电子输尿管软镜钬激光碎石术在人免疫缺陷病毒（human immunodeficiency virus,HIV）感染肾结石患者治疗中的疗效.方法 回顾性分析2015年5月至2016年5月收治的47例HIV感染肾结石患者使用电子输尿管软镜钬激光碎石术的临床资料.男29例,女18例.年龄22～56岁,平均39岁.47例中9例为双侧肾结石.单发肾盂结石26例,肾下盏结石12例,多发、铸型、鹿角状等复杂结石9例.47例患者术前均明确诊断为HIV感染.术中留置F14输尿管软镜导引鞘,导入输尿管软镜进行钬激光碎石,术后1个月统计一期结石清除率,术后残石则采取二期联合体外冲击波碎石（ESWL）.结果 手术均成功置入导引鞘且发现结石.手术时间42 ～ 141min,平均63min.术后住院时间2～ 16d,中位数4.5d.本组47例中41例一期完全粉碎并排出结石,一期结石清除率为87.2％ （41/47）.6例术后1个月二期联合ESWL,5例成功清除残石,总结石清除率97.9％（46/47）,1例联合ESWL碎石失败,再次三期行电子输尿管软镜钬激光碎石术,成功清除结石.碎石术后发热4例,经抗感染及对症治疗后体温恢复正常;所有病例围手术期无输血,无全身感染及输尿管穿孔、撕脱等手术相关并发症,总并发症发生率8.5％ （4/47）.术前CD4^＋T淋巴细胞计数250～560个/μl,平均402个/μl,术后第1天复查CD4^＋T淋巴细胞计数为280 ～550个/μl,平均390个/μl;术后第3天复查CD4＋T淋巴细胞计数为300～ 560个/μl,平均410个/μl.术后第1天及第3天CD4^＋T淋巴细胞计数与术前比较差异均无统计学意义（均P＞0.05）.结论 电子输尿管软镜钬激光碎石术治疗HIV感染肾结石操作简单、安全可靠,并发症少、疗效满意,为医护人员在治疗HIV感染患者肾结石的过程中降低了职业暴露风险.

Objective To discuss the efficacy of the flexible ureteroscopy combined with Holmium laser lithotripsy for kidney calculi with HIV positive patients.Methods From May 2015 to May 2016,47 cases of patients with renal calculi were treated by the flexible ureteroscopy combined with Holmium laser lithotripsy in our hospital.There were 29 cases male,18 cases female,aged from 22 to 56 years old,average 39 years.There were 38 cases with single stone,9 cases with multiple stones.There were 9 cases with stones on both sides.Flexible ureteroscopy channel sheath was used in surgery.Stones were fragmented by Holmium laser.During one-month follow-up after surgery,stone removal and stone free rate were recorded.Residual stones were re-treated with a secondary lithotripsy or ESWL.Results The flexible ureteroscopy channel sheath was indwelled successfully in all the cases.All stones were detected.The average operation time was 63min （range,42-141min） and the median postoperative stay was 4.5days （range,2-16 d）.Among the 47 patients,41 patients underwent first-stage lithotripsy,6 patients underwent second-stage ESWL after lithotripsy,and 1 patient underwent third-stage lithotripsy.The one-month stone free rate was 87.2% （41/47）.The total stone free rate was 97.9% （46/47） after second-stage lithotripsy.Postoperative fever occurred in 4 cases after lithotripsy.No blood transfusion,systemic infection,ureteral perforation,or ureteral avulsion occurred.The total complication rate was 8.5% （4/47）.The mean number of CD4 ＋T lymphocytes before lithotripsy was 402/μl,and was 410/μl 3 days after lithotripsy.There was no Statistical differences between them.Conclusions Flexible ureteroscopy combined Holmium laserlithotripsy could be a safe and effective treatment for kidney calculi patients with HIV/AIDS positive.