一期经输尿管硬通道硬镜钬激光碎石治疗输尿管上段结石梗阻性脓肾

One-stage rigid ureteroscopy via rigid ureteral access sheat in the treatment of upper ureteral calculus obstructive pyonephrosis

目的探讨经输尿管硬通道硬镜钬激光碎石术一期治疗输尿管上段结石梗阻性脓肾的安全性、有效性。方法 2014年3月至2017年8月,35例输尿管上段结石梗阻性脓肾施行一期经输尿管硬通道硬镜钬激光碎石治疗,35例施行一期置管引流再二期取石的分期手术治疗,比较两组的手术时间、住院天数、结石清除率、并发症发生情况。结果一期手术组与分期手术组的平均手术时间分别为(53.5±29.0)min和(56.9±28.6)min(P=0.623),平均住院天数分别为(7.1±2.7)d和(15.7±7.1)d(P<0.001),结石清除率分别为88.6%和85.7%(P=0.721),并发症发生率分别为42.9%和48.6%(P=0.631),其中全身炎症反应综合症(SIRS)发生率分别为2.9%和11.4%(P=0.353)。结论一期经输尿管硬通道硬镜钬激光碎石术治疗经筛选的输尿管上段结石梗阻性脓肾安全、有效,可缩短住院时间、缩减手术次数。

Objective To investigate the safety and efficacy of one-stage rigid ureteroscopy via rigid ureteral access sheat for upper ureteral calculus obstructive pyonephrosis. Methods During March 2014 and Aug. 2017,35 cases of upper ureteral calculus obstructive pyonephrosis underwent one-stage rigid ureteroscopy via rigid ureteral access sheat, and the other 35 cases underwent two-stage surgery （double J drainage in the first stage and rigid ureteroscopy via rigid ureteral access sheat in the second stage）. The operation time, length of hospital stay, stone free rate and complications were compared between the two groups. Results The operation time was（53.5±29.0） vs. （56.9±28.6）min （P=0. 623） ; the length of hospital stay was （7.1±2.7） vs.（15.7±7.1）days （P〈0.001）; the stone free rate was 88.6%vs.85.7%（P=0.721）; the incidence of complications was 42.9% vs.48.6% （P=0.631）,inwhich the incidence of systemic inflammatory response syndrome （SIRS） was 2.9% vs.11.4 % （P=0. 353）. Conclusion One-stage rigid ureteroscopy via rigid ureteral access sheat is a safe and effective option for carefully selected cases of upper ureteral calculus obstructive pyonephrosis,which can shorten the length of hospital stay and reduce the times of surgery.