肾结石体外冲击波碎石失败短期内行输尿管软镜治疗的疗效分析

The efficacy of flexible ureteroscopic lithotripsy for kidney stones after failure of shock wave lithotripsy

目的比较肾结石行体外冲击波碎石(ESWL)失败1周行输尿管软镜钬激光碎石术(ESWL-FURSL)与单纯行输尿管软镜钬激光碎石术(FURSL)治疗肾结石,评价短期内ESWL-FURSL的临床疗效及安全性,进而为肾结石ESWL失败患者选择合适的治疗时机。方法我们通过分析2013年6月至2016年6月期间189例肾结石患者,其中体外冲击波碎石失败1周行输尿管软镜钬激光碎石术(ESWL-FURSL)肾结石患者81例,单纯行输尿管软镜钬激光碎石术(FURSL)肾结石患者108例。比较两者之间的结石排净率、手术时间、围手术并发症的区别。结果 ESWL-FURSL组术后结石排净率略低于FURSL组(82.7%vs.87.0%),但两者之间无统计学差异(P>0.05)。ESWL-FURSL组术后血尿及术后感染发生率略高于FURSL组,但两组之间无统计学差异(P>0.05)。ESWL-FURSL组平均手术时间明显高于FURSL组(P<0.05),可能与体外冲击波碎石术后肾结石碎片较多及肾易出血有关。结论肾结石ESWL失败后短期内行FURSL,其临床疗效及术后并发症与单纯行FURSL相仿,提示ESWL失败患者术后1周行输尿管软镜治疗是比较合适的治疗时机。

Objective To assess the efficacy of flexible ureteroscopic lithotripsy（FURSL）in the treatment of kidney stones 1 week after extracorporeal shock wave lithotripsy（ESWL）failure.Methods The clinical data of 189 patients with kidney stones treated during June 2013 and June 2016 were retrospectively analyzed.The patients were divided into 2 groups：those who received ESWL-FURSL（n=81）and those who received FURSL only（n=108）.The stone-free rate,operation time and complications were compared.Results The stone-free rate was 82.7% and 87.0% respectively in the ESWLFURSL group and FURSL group,with no significant difference（P〈0.05）.The incidences of postoperative hematuria and infection were slightly higher in the ESWL-FURSL group than in the FURSL group,but the differences were not statistically significant（P〈0.05）.The mean operation time was longer in the ESWL-FURSL group than in the FURSL group,with statistical difference（P〈0.05）,which might be related to the more renal stone fragments and hemorrhage after ESWL.Conclusions Complementary FURSL may be used safely after ESWL failure in the short term.Its effectiveness and morbidities are similar those of primary FURSL.It is appropriate to perform FURS 1 week after ESWL failure.