一期输尿管软镜碎石取石术(附96例报告)

One-stage Flexible Ureteroscopic Lithotripsy:Report of 96 Cases

目的探讨一期输尿管软镜碎石取石术的安全性和有效性。方法2016年1月~2018年12月对96例上尿路结石行输尿管软镜碎石取石术,其中输尿管结石24例,肾结石60例(多发16例),输尿管结石合并肾结石12例。肾结石长径0.5~3.2 cm,平均1.5 cm,上盏22例,中盏或肾盂38例,下盏53例;输尿管结石长径0.6~2.4 cm,平均1.2 cm,中段1例,其余均位于上段。术前不放置输尿管支架管。使用F 8 Stroz电子输尿管软镜,钬激光粉碎结石,较大碎石块用套石网篮取出。结果95例软镜鞘(F 10/12或F 12/14)置入成功,1例置入F 10/12软镜鞘失败;95例一次碎石成功,1例输尿管结石碎石后发现肾盂积脓,二期处理肾结石。术中肾实质损伤1例,无输尿管穿孔、撕脱、出血等需处理的并发症。术后发热11例,无尿源性脓毒血症。术后1、3个月结石清除率分别为84.4%(81/96)和88.5%(85/96)。结论一期输尿管软镜碎石取石术安全、有效。

Objective To evaluate the safety,efficacy and feasibility of flexible ureteroscopic lithotripsy without preoperative ureteral stenting.Methods From January 2016 to December 2018,96 cases of upper urinary calculi were treated with ureteroscopic lithotripsy,including 24 cases of ureteral calculi,60 cases of renal calculi(16 multiple cases),and 12 cases of ureteral calculi combined with renal calculi.The size of kidney stones was 0.5-3.2 cm,with an average of 1.5 cm.There were 22 cases of upper calyx,38 cases of middle calyx,and 53 cases of lower calyx.Ureteral calculi were 0.6-2.4 cm in size(mean,1.2 cm).There were 1 case in the middle segment and other cases located in the upper segment.No stenting was placed before surgery.By using F 8 Stroz electronic ureteroscope and holmium laser,the stones were fragmented and taken out with a stone basket.Results A total of 95 cases were implanted successfully(F 10/12 or F 12/14),and 1 case failed to insert F10/12 sheath.The primary lithotripsy succeeded in 95 cases.One case of pyonephrosis was found after ureterolith lithotripsy,and renal calculus was treated in the second stage.Intraoperative renal parenchyma injury was noted in 1 case,and no complications happened such as bleeding,ureter perforation or avulsion.Postoperative fever occurred in 11 cases.No urinary sepsis happened.Stone clearance rate were 84.4%(81/96)and 88.5%(85/96)respectively after postoperative 1 and 3 months.Conclusion Flexible ureterroscopic lithotripsy without preoperative ureteral stenting is safe,effective and feasible.