输尿管纤维软镜治疗肾结石350例的疗效分析

Analysis of the efficacy of flexible ureteroscope in the treatment of 350 cases of renal calculi

目的对输尿管纤维软镜治疗肾结石的疗效进行分析总结。方法收集2015年1月至2018年12月使用输尿管纤维软镜联合钬激光治疗的350例肾结石患者的资料,分析患者置鞘成功率、碎石成功率、残石率、手术时间、严重并发症。结果置鞘成功率:24例预留双J管,二期置鞘成功率100.0%,326例一期置鞘成功率92.9%(303/326),两组比较差异无统计学意义(χ^2=0.845,P=0.358)。碎石成功率:肾上盏结石76例,2例碎石未成功,成功率97.4%;肾盂结石107例、肾中盏结石109例,均碎石成功,成功率100.0%;肾下盏结石58例,6例碎石未成功,成功率89.7%,总的成功率为97.7%。残石率:术后1个月影像学复查,以残石≥4 mm视为残石,19例有残石,占5.4%。手术时间:330例结石1.0~2.0 cm,均顺利完成手术,手术时间30~70 min,平均55 min;20例结石2.1~3.6 cm,手术时间50~140 min,平均85 min。严重并发症:术后尿脓毒血症5例,其中1例死亡。结论输尿管纤维软镜治疗肾结石安全、有效,但有潜在的高危风险,涵盖在置鞘、术后并发症的处理等过程。

Objective To analyze and summarize the curative effect of flexible ureteroscope on 350 cases of renal calculi.Methods Data were collected from 350 patients with renal stones treated with flexible ureteroscope and holmium laser from January 2015 to December 2018,and analyzed the success rate of sheath placement,lithotripsy success rate,residual stone rate,operation time,and serious complications.Results Sheath success rate:24 cases reserved double J tubes,the success rate of the second stage sheath was 100.0%,and the success rate of the first stage sheath of 326 cases was 92.9%(303/326).There was no significant difference between the two groups(χ^2=0.845,P=0.358).Lithotripsy success rate:76 cases of upper kidney stones,2 cases of unsuccessful,success rate is 97.4%(74/76);107 cases of renal pelvis stones,109 cases of kidney stones,all lithotripsy,success rate is 100.0%;lower kidney stones in 58 cases,6 cases of lithotripsy were unsuccessful,with a success rate of 89.7%(52/58)and a total success rate of 97.7%.Residual stone rate:Imaging examination was performed one month after surgery.Residual stones≥4 mm were considered as residual.19 patients had residual stones,accounting for 5.4%(19/352).The operation time:330 cases of lithotripsy 1.0-2.0 cm,all successfully completed surgery,the operation time was 30-70 minutes,on average of 55 minutes;20 cases of lithotripsy ranged from 2.1 to 3.6 cm,the operation time ranged from 50 to 140 minutes,on average of 85 minutes.Serious complications:5 cases of postoperative urinary sepsis,including 1 death.Conclusion Flexible ureteroscope is a safe and effective treatment for renal calculi though with potential risks.It could be performed through the process of sheathing and postoperative complications.