输尿管鞘配合半硬性及软性输尿管镜治疗大于2cm及鹿角形肾结石疗效分析

Efficacy of semi rigid and flexible ureteroscopy combined with ureteral sheath in treating staghorn renal calculi and those larger than 2 cm

目的探讨输尿管鞘配合半硬性及软性输尿管镜下钬激光碎石术逆行治疗大于2 cm及鹿角形肾结石的临床疗效及安全性。方法采用输尿管鞘配合半硬性及软性输尿管镜下钬激光碎石术治疗大于2 cm单一及鹿角形肾结石患者22例。比较结石最大直径>3 cm组(n=7)和结石最大直径2~3 cm组(n=15)的结石CT值、手术时间、一期清石率、术后发热比例、拔除双J管时间、术后住院天数。结果结石最大直径2~3 cm组手术时间和拔除双J管时间短于结石最大直径>3 cm组,术后发热比例低于结石最大直径>3 cm组,一期SFR高于结石最大直径>3 cm组,差异均有统计学意义(P<0.05);两组结石CT值、一期术后住院天数比较差异无统计学意义(P>0.05)。结论对比结石最大直径>3 cm患者,输尿管鞘配合半硬性及软性输尿管镜治疗结石最大直径2~3 cm患者的手术时间短,一期清石率高,拔除双J管时间短,术后发热比例低。

Objective To determine the effect and safety of semi rigid and flexible ureteroscopy combined with ureteral sheath as a technology for the treatment of kidney stones large than 2 cm and staghorn renal calculi. Methods A total of 22 patients with kidney stones were treated by semi rigid ureteroscopy through ureteral sheath, coupled with flexible ureterorenoscopy lithotripsy. The first group （ n =15） had stones whose size being equal to or less than 3 cm in diameter. The second group （ n =7） had stones whose size being larger than 3 cm in diameter. The CT value, the operation time, the stone free rate, postoperative fever rate, stent retained time and postoperative hospitalization time of the two groups were then compared. Results The operative time of the first group and the time of removing the double J tubes were shorter than that of the second group. The postoperative fever rate of the first group was lower than that of the second group. The one-stage stone free rate was higher than that of the second group. The differences were significant （ P 〈0.05）. No significant difference was found between the two groups in the CT value of the stones and the length of postoperative hospital stay （ P 〉0.05）. Conclusions Compared with the treatment of patients with the maximum diameter of stones being more than 3 cm, ureteral sheath combined with semi rigid and flexible ureteroscopy for the treatment of patients with the maximal diameter of stones being between 2 to 3 cm has shorter operative time, higher rate of stone clearance in one period, shorter time for the removal of double J tubes, and lower postoperative fever rate.