输尿管软硬一体镜治疗上尿路结石90例单中心经验

Analysis of flexible combined with hard lens of ureteroscope and Holmium Laser Lithotripsy for upper ureteral/renal stones in a single center 90 cases

目的 :探讨输尿管软硬一体镜下钬激光碎石术治疗上尿路结石的安全性和疗效。方法 :回顾性分析2013年1月—2016年7月南通大学附属医院泌尿外科利用输尿管软硬一体镜合并钬激光碎石治疗的90例输尿管上段/肾结石(<2.5 cm)患者的临床特点,手术经过、治疗体会及随访情况,并结合相关文献进行探讨。结果:75例患者顺利碎石,一次碎石成功率83.3%,手术时间38.8~83.4 min,平均47.3 min,术中出血量少,术后无输尿管穿孔、高热、败血症等情况。6例术后肾-输尿管-膀胱摄影(kidney,ureter,bladder,KUB)显示有6~8 mm结石残留,经体外冲击波碎石(extrocorporeal shock wave lithotripsy,ESWL)后2周复查结石排尽;3例留置J管2周后输尿管仍因扭曲狭窄无法进镜而放弃治疗,2例因结石位于下盏,夹角过大,碎石过程中光纤打断被迫中止改用输尿管软镜。4例因结石残留过大行二次电子软镜碎石。结论:输尿管软硬一体镜联合钬激光碎石术治疗上尿路结石安全、方便、疗效可靠,尤其在处理输尿管上段结石和肾盂及肾中盏、上盏结石上疗效显著。

Objective:To investigate the safety and therapeutic effect of Holmium Laser Lithotripsy in the treatment of upper urinary calculi through flexible combined with hard lens of ureteroscope.Methods:The clinical features,diagnosis and treatment profiles of 90 cases of upper ureteral/renal stones(the diameter of these stones is less than 2.5 cm)admitted in Affiliated Hospital of Nantong University from January 2013 to July 2016 were analyzed retrospectively.Results:Lithotripsy was performed successfully in 81 patients and the success rate of one-time lithotripsy was 90%;the operation time was 38.8-83.4 min(averagely 47.3 min);and the bleeding in the operation was less.There were no ureteral perforation,high fever or septicaemia.6 cases showed residual stones of 6-8 mm in the kidney,ureter,bladder(KUB)and were cured by extrocorporeal shock wave lithotripsy(ESWL),three still failed due to ureter stricture after left the double-J for two weeks.Two failed due to the big renal calyx-neck angle.When we reach lower renal calyx,the fibre-optical was broken and we transferred to flexible Ureteroscope.Four were transferred to electronic flexible ureteroscope due to the big remained stones.Conclusion:Flexible combined with hard lens of ureteroscope and Holmium Laser Lithotripsy for upper urinary calculi is safety,convenient and effective,especially for upper ureteral,renal pelvis,middle calyx,upper calyx stones.