输尿管软镜钬激光碎石术治疗肾大体积结石的效果观察

Observation on efficacy of flexible ureteroscopic lithotripsy with holmium laser for treating large-volume renal calculi

目的探讨输尿管软镜钬激光碎石术治疗大体积肾结石的效果。方法选择接受输尿管软镜钬激光碎石术治疗的大体积(直径大于3 cm)肾结石患者46例为观察组;另取同一术者在同日或近期所行输尿管软镜碎石术,结石最大径小于3 cm的肾结石患者46例为对照组。对两组手术时间、结石清除率及术后并发症进行对比分析。结果观察组36例患者一次手术治愈,两次手术者8例,3次手术者1例,4次手术者1例,结石清除率为89. 1%,手术时间(86. 0±3. 2) min。术后发热(T> 38℃)6例,其中高热2例,无感染性休克,术后石街形成5例。对照组46例均一次完成手术,结石清除率为91. 3%,手术时间(38. 1±2. 5)min,术后发热(T> 38℃)3例,无感染性休克,术后石街形成1例。观察组手术时间长于对照组(P <0. 05);两组术后并发症发生率、结石清除率比较,差异均无统计学意义(均P> 0. 05)。结论输尿管软镜钬激光碎石术可有效清除大体积肾结石,且不增加术后并发症。

Objective To explore the feasibility of flexible ureteroscopic lithotripsy(FURL) with holmium laser for treating large-volume renal calculi. Methods Forty-six patients with large-volume(diameter > 3 cm) renal calculi undergoing FURL with holmium laser were enrolled as observation group.Another 46 renal calculi patients with the maximum calculary diameter < 3 cm underwent FURL on the same day or recently by the same surgeon,and were enrolled as control group. The duration of operation,clearance rate of calculi and postoperative complications were analyzed and compared between the two groups.Results In the observation group,36 patients were cured by the first surgery,8 patients by the second surgery,1 patient by the third surgery,and 1 patient by the fourth surgery; the clearance rate of calculi was89. 1%; the duration of operation was(86. 0 ± 3. 2) min; postoperative fever(T > 38℃) occurred in 6 cases involving 2 cases with hyperpyrexia; no septic shock occurred,and steinstrasse occurred in 5 cases after surgery. In the control group,all of the 46 patients were cured by the first surgery,and the clearance rate of calculi was 93. 1%; the duration of operation was(38. 1 ± 2. 5) min; postoperative fever(T > 38℃) occurred in 3 cases; no septic shock occurred,and steinstrasse occurred in 1 cases after surgery. The duration of operation was longer in the observation group compared to the control group(P < 0. 05); there were no statistical differences in the incident rate of postoperative complications,postoperative fever and the clearance rate of calculi between the two groups(all P > 0. 05). Conclusion FURL with holmium laser can effectively remove the large-volume renal calculi but does not increase the postoperative complications.