采用软性输尿管镜技术处理经皮肾镜取石术残留结石临床分析

Flexible ureterscopy for the treatment of residual stones after percutaneous nephrolithotomy

目的探讨采用软性输尿管镜技术处理经皮肾镜取石术（percutaneousnephrolithotomy，PCNL）残留结石的临床应用价值。方法选择2014年12月至2016年10月期间，在本院行PCNL，残留有结石的患者52例，采用逆行经腔内碎石（retrogradeintrarenalsurgery，RIRS）或顺行经肾造瘘通道输尿管软镜碎石（anterogradeflexibleureterscopy，AFU）进行治疗。统计手术相关临床指标进行分析。结果47例（90．4％）直接行RIRS；5例（9．6％）行AFU，其中2例失败，保留肾造瘘管择期行RIRS成功。行RIRS的49例患者中，5例（10．2％）行2次RIRS，44例（89．8％）仅行一次RIRS。软性输尿管镜操作手术时间20～90min，平均（42±17）min。48例（92．3％）成功找到肾内全部结石并完全击碎，2例（4％）未能全部找到。肾内结石，2例（4％）找到结石，但因角度大无法碎石。术后出现发热2例。留置肾造瘘管的10例患者术后均无发热。术中、术后无严重血尿病例及输血病例。平均术后出院时间（1．3±0．3）d。术后2～8周全部患者回院复诊并拔除双“J”管。拔除双“J”管当日发现肾内或输尿管上段仍有残留结石（已经击碎，碎石直径小于3mm）23例（57．7％）。4例结石未能完成碎石的患者中，3例行冲击波碎石术（shockwarelithotripsy，SWL），1例长期随诊处理。拔除双“J”管后33例随诊1-6个月，其中28例（84．8％）结石排净。结论软性输尿管镜技术是处理PCNL术残留结石的有效手段。

Objective To evaluate the clinical value of flexible ureterscopy for the treatment of residual stones after percutaneous nephrolithotomy （PCNL）. Methods A total of 52 cases who under- went PCNL with resident stones in our hospital from December 2014 to October 2016 were included in our study. They were treated subsequently using the technique of flexible ureterscopy （ retrograde intra- renal surgery, RIRS, or anterograde flexible ureterscopy, AFU, through the percutaneous access tracts）. The clinic data were recorded, including the operating time, the postoperative stay, the fever and urosepsis rates, the transfusion rate, second RIRS procedure rate, the clearance rate. Results Forty- seven cases （90.4%） were treated by RIRS, with 100% successive placement of the shelf. Five cases （9.6%） were treated by AFU through the percutaneous tracts, while 2 cases failed and were successively underwent RIRS subsequently. The average time of flexible ureterscopy was 20 - 90 min, average （42 ± 17） rain. Among those who underwent RIRS, 5 cases （ 10.2% ） received two RIRS procedures, while 44 cases （89.8%） received only one RIRS procedures. There were still re- sidual stones in 4 cases after the treatment. For the complication, only two cases had the fever after the flexible ureterscopy. None of the patient who had the renal drainage and fever. No transfusion case. The post operation stays were （1.3 ±0.3） d. After 1 ~6 months of the follow up,28 cases （84.8%） had the clearance rate. Conclusions It is safe and effective to treat the residual stones after PCNLby flexible ureterscopy.