电子输尿管软镜联合钬激光治疗直径≤2cm上尿路结石的优势探讨

Observation of Electronic Flexible Ureteroscopy and Holium Laser Lithotripsy for the Treatment of Less than 2cm Upper Urinary Calculi

目的探讨电子输尿管软镜联合钬激光治疗直径≤2cm肾输尿管上段结石的有效性和优势。方法分析2015年9月至2017年1月本院应用电子输尿管软镜联合国产钬激光治疗62例73侧上尿路结石临床资料,男41例,女21例;年龄25~80岁,平均47.9岁。左侧24例,右侧27例,双侧11例,结石单发28例,多发45例。最大结石直径2~20mm,平均11.9mm。61例术前1~2周预留双J管行被动扩张。术中先留置外径14F/16F输尿管鞘,采用Olympus电子软镜及国产200μm钬激光纤进行碎石,碎石后常规以套石篮取石。术后1~3天及术后1个月分别复查尿路X线片或B超,计算即刻清除率及术后1个月结石清除率。结果 62例(73侧)均顺利完成手术,平均手术时间80分钟,结石寻及率100%(包括1例憩室内结石),碎石率100%。术后平均住院时间4.1天。16例(21.9%)患者出现发热。即刻结石清除率65.8%(48/73),1个月后复查结石清除率79.5%(58/73)。按术前结石停留部位不同分为:输尿管上段、中上盏、下盏、多部位多发(代表上述三个部位以上存在结石),不同部位的结石在手术时间、术后即刻清除率、1个月后清除率及术后住院日的比较无统计学差异(P>0.05)。结论电子软镜联合钬激光治疗上尿路结石安全、有效。在结石负荷较小的情况下,不同部位的结石在手术时间、结石清除率的比较方面无明显差异。

Objective To investigate the effectiveness and advantages of electronic flexible ureteroscopy combined with holmium laser lithotripsy for the treatment of ureteral and renal calculi which diameters less than 2 cm.Methods From September 2015 to January 2017,we used digital flexible ureteroscope combined with domestic holmium laser lithotripsy for the treatment of 62 cases of upper urinary tract calculi in 73 sides. Of these 62 patients,the average age was 47 years,with 41 males and 21 females. 24 cases in left side,27 cases in right side,11 cases were bilateral calculi. The stones were single in 28 cases and multiple in 45 cases. The maximum stone diameter ranged from 2 to 20 mm（ 11. 9 mm in average）. 1 ~ 2 weeks before operation,61 patients received double J stent placement for passive expansion. After 14 F/16 F ureter sheath indwelling,the Olympus digital flexible ureroscopy and domestic 200μm holmium laser were used for the lithotripsy. The stone fragment were moved outside conventionally with baskets. Patients were re-examined by X-ray or ultrasound 1 ~ 3 days and one month postoperatively for the evaluation of the immediate stone clearance rate and one month stone clearance rate. Results Sixty-two cases（ 73 sides） were successfully operated,the average operation time was 80 minutes,the average hospital stay was 4. 1 days,16 cases（ 21. 9%） had a complication of fever. Immediate stone clearance rate was 65. 8%（ 48/73）,one-month stone clearance rate was 79. 5%（ 58/73）. According to the different stone locations,patients were divided into： upper ureter,upper-middle calyx,lower calyx,and multiple location groups. There is no significant difference in operation time and stone clearance rate among these groups（ P 〉0. 05）. Conclusions The digital flexible ureroscopy combined with holium laser lithotripsy in the treatment of upper urinary calculi is effective. In the case of small stone burden,there was no significant difference in operation time and stone clearance rate between different stone locations.