Ⅰ期输尿管软镜下钬激光治疗直径<2cm肾结石临床疗效分析

Ⅰ Stage Flexible Ureteroscope and Holmium Laser Lithotripsy for the Treatment of Renal Calculi with Diameter Less than 2cm: A Clinical Study

目的探讨Ⅰ期输尿管软镜下钬激光治疗直径<2cm肾结石的安全性和有效性。方法回顾性分析2016年4月至2017年5月期间本科输尿管软镜钬激光碎石术病例36例,其中男性17例,女性19例,Ⅰ期手术20例,Ⅱ期手术16例,结石直径0.6~2.0cm,平均1.2cm。全麻下使用STORZ Flexible-X 7.5Fr输尿管软镜寻找到结石,使用200μm激光光纤,调节功率为0.8~1.0 J/10~15Hz碎石。术后均留置双J管至术后4周拔出,1个月后复查CT评估手术效果。结果 36例患者均顺利完成手术,手术时间35~60分钟,平均50分钟。Ⅰ期碎石成功率90%(18/20)。2例患者Ⅰ期置镜失败留置双J管10~14天后改行Ⅱ期手术,Ⅱ期手术成功率100%(18/18)。术中无明显出血,术后住院时间2~5天,平均3天。1例女性患者术后反复发热加强抗感染治疗后治愈。拔出双J管后1个月复查CT,其中有5例残留<0.4cm结石,2例位于肾下盏,3例位于多肾盏。结论对结石直径<2cm肾结石Ⅰ期碎石成功率高,安全有效。

Objective To investigate the safety and efficacy of Ⅰ stage flexible ureteroscope and holmium laser lithotripsy for the treatment of the renal calculi with diameter less than 2 cm. Methods 36 cases treated by flexible ureteroscope and holmium laser lithotripsy from April 2016 to May 2017 were retrospectively analyzed.There were 17 male and 19 female cases. 20 cases underwent stage Ⅰ surgery,and 16 cases underwent Ⅱ stage surgery. The average diameter of the renal calculi was 1. 2 cm（ ranged from 0. 6 to 2. 0 cm）. The STORZ Flexible-X 7. 5 F ureteroscope were used to locate the stones under the general anesthesia using 200μm laser power（ 0. 8-1. 0 J/10-15 Hz） for the lithotripsy. The double J stents were kept for 4 weeks postoperatively,and CT scans were performed to evaluate the postopertive effect of operation 1 month after the surgery. Results All these36 cases were successfully completed. The average operation time was 50 minutes,ranged from 35 to 60 minutes. 90%（ 18/20） cases were successfully done by Ⅰ stage,the failed 2 patients were kept the double J stent for 10-14 days and successfully completed in the stage Ⅱ surgery. 100%（ 18/18） cases were successfully done in Ⅱ stages surgery. No significant intraoperative bleeding,the average postoperative hospital stay was 3 days（ ranged from 2 to 5 days）. 1 female patients suffered from postoperative fever,and cured by strengthen antibiotic treatment. The follow up CT scans showed residual stones in 5 cases,the diameters of which were less than 0. 4 cm,located in the lower calyx（ 2 cases）,and in multiple renal calyxes（ 3 cases）. Conclusions Ⅰstage flexible ureteroscope and holmium laser lithotripsy for the treatment of the renal calculi with diameter less than 2 cm is safe and effective.