输尿管软镜碎石术治疗孤立肾上尿路结石36例

Flexible Ureteroscopic Lithotripsy for Upper Urinary Tract Calculi in Solitary Kidney:Report of 36 Cases

目的探讨输尿管软镜碎石术治疗孤立肾上尿路结石的疗效和安全性。方法我院2013年6月～2018年3月采用输尿管软镜碎石术治疗孤立肾上尿路结石36例,取截石位,沿导丝置入输尿管外鞘,插入输尿管软镜,钬激光将结石击碎至3 mm以下,然后用套石网篮取出结石。结果手术时间48～143 min,(82.7±15.9)min。术中出血1～15 ml,(3.4±0.9)ml。肾盂/肾盏黏膜损伤5例(13.9%),术后发热10例(27.8%),其中1例脓毒败血症经抢救后顺利出院,术后输尿管狭窄1例。一期清除结石17例(47.2%),二期清除结石13例(36.1%),联合体外冲击波碎石(extracorporeal shock wave lithotripsy,ESWL)排净6例(16.7%)。33例随访3个月～4年(中位随访时间2.7年):4例结石复发,行ESWL后排出;随访终点血肌酐(103.4±35.2)μmol/L,6例仍有肾功能不全,1例需长期血透治疗。结论输尿管软镜碎石术治疗孤立肾上尿路结石安全、有效,感染是主要并发症。

Objective To investigate the efficacy and safety of flexible ureteroseopie lithotripsy for upper urinary tract calculi in solitary kidney. Methods From June 2013 to March 2018, 36 patients with upper urinary tract calculi in solitary kidney were treated with flexible ureteroseopie lithotripsy. The lithotomy position was taken, an ureteral sheath was inserted along the guide wire, the ureteral soft lens was inserted retrogradely, and the stones were fragmented below 3 mm by holmium laser which were removed with a stone basket. Results The operation time was 48 - 143 min （ mean, 82.7 ± 15.9 min） , and the intraoperative hemorrhage was l - 15 ml （ mean, 3.4 ± 0.9 ml）. There were 5 eases of renal pelvis/calyx mueosa injury （ 13.9% ） , 1 ease of ureteral stricture after operation, and 10 eases of fever after operation （27.8%） , 1 of which sufl＇ered from pyaemia septiea and was discharged successfully after salvage. The stones were completely cleared on one session in 17 eases （47. 2% ）, with two-staged operation in 13 eases （36. 1% ） , and combined with ESWL in 6 eases （ 16.7% ）. A total of 33 eases were followed up for 3 months to 4 years （median, 2.7 years）. There were 4 eases of recurrence which were discharged after extraeorporeal shock wave lithotripsy. The mean blood ereatinine at the final follow-up was （ 103.4 ± 35.2） μmol/L. Six eases still had renal insufficiency and 1 ease needed long-term hemodialysis. Conclusions Flexible ureteroseopie lithotripsy is safe and effective to the treatment of upper urinary tract calculi in solitary kidney. Infection is the main complication.