输尿管软镜块状碎石法结合取石篮在治疗肾结石中的运用

Application of flexible ureteroscope-guided blocky lithotripsy combined with stone extractor in treatment of renal calculi

目的:探讨输尿管软镜"块状碎石法"结合取石篮在治疗肾结石中的运用。方法:选择68例肾结石患者,采用输尿管软镜治疗。入选病例结石直径为1.0~1.5cm,CT值470~1 516HU,随机分组,其中32例采用块状碎石法结合软镜取石篮,即碎石效果为块状,直径3~4mm,碎石后使用取石篮套出结石(块状法组);36例采用输尿管软镜粉末化碎石法,即碎石直径在2mm以下,碎石后不使用取石篮(粉末化组)。比较两组手术时间、清石率,观察不良反应发生情况。结果:块状法组碎石取石时间为6~32min,平均23.3min,结石清除率为97%,术后无发热病例;粉末化组碎石取石时间为7~40min,平均28.6min,结石清除率为86%,术后2例出现发热症状。结论:输尿管软镜块状碎石法结合取石篮较粉末化碎石法能有效降低手术并发症,提高清石率,有效缩短手术时间,是优先选择的碎石方法。

Objective：To investigate the appropriate lithotripsy for the treatment of renal calculi under a flexible ureteroscope.Method：A total of 68 patients with renal calculi treated with a flexible ureteroscope were selected,and randomly divided into two groups.Among the included patients（diameter of calculi,1.0-1.5 cm;CT value,470-1 516 HU）,32 patients（blocky lithotripsy group）received blocky lithotripsy combined with stone extractor（renal calculi were crushed into blocks with a diameter of 3-4 mm）,and the other 36 patients（powdered lithotripsy group）underwent powdered lithotripsy without stone extractor（diameter2 mm）.Operative time and stone free rate were compared between the two groups,and adverse reactions were observed.Result：In the blocky lithotripsy group,the longest lithotripsy duration was 32 min and the shortest duration was 6 min（median duration,23.3 min）,stone free rate was 97%,and no postoperative fever was found（0/32）.In the powdered lithotripsy group,the longest and shortest lithotripsy duration was 40 min and 7 min,respectively（median duration,28.6 min）,stone free rate was 86%,and postoperative fever was detected in two patients（2/36）.Conclusion：Compared with powdered lithotripsy,flexible ureteroscope-guided blocky lithotripsy combined with stone extractor is the preferred method for it can effectively reduce surgical complications,increase stone free rate and shorten operative time.