输尿管软镜术联合钬激光术治疗肾结石的疗效及安全性研究

Efficacy and safety of flexible ureteroscopy with holmium laser lithotripsy for kidney stones

目的评价输尿管软镜术结合钬激光术治疗直径≤25 mm肾结石采用的疗效和安全性。方法收集2014年12月至2017年6月收治的86例肾结石患者作为研究对象。术前常规留置输尿管支架管扩张输尿管2周以上,全身麻醉下,放置输尿管软镜进行钬激光术碎石,评价其疗效和安全性。结果 86例患者全部一期碎石成功,手术时长33~70 min,平均时长42 min。术后住院时长2~6 d,平均(3±1)d。术后2、4周肾结石清除率分别为87.21%(75/86)和93.02%(80/86)。术后出现发热3例,最高体温39.8℃。未发生感染性休克者、输尿管穿孔、输尿管黏膜完全脱套及严重出血等影响手术进行的不良反应。结论对于合适的肾中上盏及肾盂结石,输尿管软镜术是安全有效的手术方法,可避免PCNL的大出血和感染等并发症,减少了患者痛苦,有很大的推广应用价值。

Objective To evaluate the efficacy and safety of combined flexible ureteroscopy with holmium laser lithotripsy for the treatment of kidney stones with a diameter ≤25 mm. Methods A total of 86 patients with kidney stones admitted to our hospital were enrolled from December 2014 to June 2017. All patients received ureteral stent to dilate the ureter over 2 weeks before surgery,and underwent flexible uretersoscopy with holmium laser lithotripsy under general anesthesia. The efficacy and safety were evaluated. Results The kidney stones were successfully crushed in the first stage in all 86 patients. Operation lasted from 33 to 70 min,with a mean time of 42 min. Mean postoperative hospital stay was(3 ± 1) d( ranging from 2 to 6 days). Overall stone-free rate was 87. 21%(75/86) and 93. 02%(80/86),respectively at the 2 nd and 4 th week after operation. Postoperative fever occurred in 3 patient(maximal 39. 8 ℃). No adverse reactions affecting the surgical procedures developed,including infective shock,ureteral perforation,complete removal of ureteral mucosa and severe bleeding. Conclusion Flexible ureteroscopy is an effective and safe approach to removal of stones in the upper renal pelvis and renal pelvis,and may prevent massive bleeding and infections from conventional percutaneous nephrolithotomy and reduce the pain of patients in surgery.