输尿管软镜技术在飞行员肾结石诊治中价值及应用策略

Value and application of flexible ureteroscopic lithotripsy in diagnosis and treatment of renal calculi in pilots

目的通过对输尿管软镜(FURL)技术鉴别诊断飞行员结石,提出FURL在处理该类特殊人群肾内游离结石的安全性和有效性。方法选择2017年3月至2019年3月在上海交通大学医学院附属新华医院经CT泌尿系统造影(CTU)显示肾内高密度影飞行员共35例,均为男性;年龄23~53岁,平均年龄38.93岁。分析FURL诊断情况,以及碎石清除率。结果35例患者均成功完成FURL,确诊结石30例(85.71%),肾乳头钙化8例;30例中一次碎石清除25例(清除率83.33%),另5例经二次手术实现结石完全清除,二期清理成功。未出现泌尿系统严重出血、感染、尿路撕裂损伤等并发症。35例患者停飞观察1~96周,均成功复飞,未出现结石复发。结论FURL能及时、准确鉴别飞行员肾内微小结石,结合术前CTU显像可提高结石定位,提高一次结石清除率,减少手术创伤、结石遗漏或残留,降低二次手术风险;FURL在鉴别和治疗飞行员肾内游离微小结石有较好的应用安全性和有效性。

Objective To study safety and efficacy of flexible ureteroscopic lithotripsy(FURL)in diagnosis and intervention treatment of renal calculi in pilots with intrarenal free microlithiasis.Methods From March 2017 to March 2019,a total of 35 male pilots diagnosed as intrarenal high density shadow by CT urography(CTU)were enrolled,aged 23-53 years old with mean age of 38.93 years old.The FURL diagnosis and removal rate were analyzed.Results All of them successfully completed FURL.Thirty patients(85.71%)were diagnosed with stones,8 with renal papillary calcification;Among 30 cases,25 cases(removal rate of 83.33%)were treated with lithotripsy,5 cases were completely removed by the second operation,and the second stage was successfully removed.There were no complications such as severe urinary bleeding,infection,and urinary tract tear injury.Thirty-five cases were suspended for 1-96 weeks and successfully returned flight without recurrence of stones.Conclusion It is demonstrated that FURL could timely and accurately identify intrarenal free microlithiasis in pilot.Combined with preoperative CTU imaging,it could improve stone positioning and primary stone removal rate,decrease surgical trauma,stone missing or residual,and reduce the risk of secondary surgery.FURL has good safety and effectiveness in identifying and treating of intrarenal free microlithiasis in pilot.