末段可弯硬性输尿管肾镜联合钬激光治疗长径<2 cm肾结石的疗效观察

Clinical efficacy of Sun’s tip-flexible ureterorenoscopy combined with holmium laser lithotripsy for treatment of kidney stone less than 2 cm

目的应用末段可弯硬性输尿管肾镜联合钬激光治疗长径<2 cm的肾结石,评价安全性及疗效。方法回顾性分析我院2016年4月至2017年2月收治的58例应用末段可弯硬性输尿管肾镜治疗长径<2 cm的肾结石患者的临床资料。其中男36例,女22例,患者平均年龄(37±11)岁,结石直径0.9~2.0 cm。术前均经彩超、静脉尿路造影、CT诊断为肾结石,观察该术式的进镜成功率、手术时间、碎石成功率、结石清除率、并发症、住院时间及治疗费用等。结果末段可弯硬性输尿管肾镜单次进镜成功率96.6%(56/58),2例患者因输尿管膀胱开口处狭窄和输尿管扭曲无法进镜改二期手术和经皮肾镜碎石。钬激光碎石成功率91.4%(53/58),平均手术时间(44±9)min,术后4周结石清除率84.5%(49/58),所有患者无严重并发症。结论末段可弯硬性输尿管肾镜联合钬激光治疗长径<2 cm肾结石疗效确切、安全性高、并发症少、费用低,值得应用和推广。

Objective To evaluate the clinical efficacy and safety of Sun’s tip-flexible ureterorenoscopy(tf-URS) combined with holmium laser lithotripsy for treatment of kidney stone less than 2 cm. Methods The data of 58 cases with kidney stone treated by tf-URS were analyzed in our hospital from April 2016 to February 2017.There were 36 males and 22 females with a mean age of(37±11) years. Stone size was 0.9-2.0 cm. All the patients were diagnosed by color ultrasound, intravenous urography(IVU) or CT. The success-rate of endoscopic insertion,operation time, the successrate of lithotripsy, clearance rate of calculi, postoperative complications, hospital stay and hospitalization expenses were observed. Results The success rate of tf-URS insertion was 96.6%(56/58), The calculi were detected in 56 cases, and the procedures succeed in 53 of them(53/58, 91.4%). Two patients suffered ureterostenosis or ureteral distortion were changed to second surgery or PCNL. The average operation time was(44±9) min. 49 cases had stone clearance at 4 weeks after primary operation. No serious complication occurred. Conclusions The tf-URS with holmium laser for the treatment of kidney stone less than 2 cm is effective, safe, low incidence of complications and low cost, worthy of further application and promotion.