输尿管软镜下钬激光治疗海绵肾结石的临床效果

Clinical effect of holmium laser treatment of sponge kidney stones under flexible ureteroscope

目的观察输尿管软镜下钬激光碎石术在海绵肾结石治疗中的临床效果与安全性。方法选取我院2012年9月至2014年9月收治的有症状及有继发性病变的5例海绵肾结石患者,进行输尿管软镜下钬激光碎石技术治疗。观察患者术后临床症状缓解及术中、术后并发症等情况,定期复查肾功能、泌尿系彩超及KUB平片。结果5例海绵肾结石患者中,3例为双侧,共实施了6次手术。2例患者UPJ处存在结石坎顿并发现肾盂肾盏游离结石及乳头部黏膜下结石。钬激光将结石予以击碎,黏膜下结石予切开黏膜击碎结石。术后1、3、7 d肾功能正常,有梗阻的患者肾绞痛症状消失,其他患者腰痛症状也有减轻,所有患者均有结石碎屑自行排出。术后1、3、6个月,复查影像所见患者结石数量均有不同程度减少。除第1例患者双侧肾脏结石手术后发生尿源性脓毒血症,经治疗后痊愈,其余患者未见明显并发症。结论输尿管软镜钬激光碎石术治疗海绵肾结石可显著减少患者的结石负荷,只要术前准备充分、术中操作合理,其不失为一种微创、安全、有效的治疗方法。

Objective To observe the clinical effect and safety of holmium laser lithotripsy under flexible ureteroscope in the treatment of sponge kidney stones.Methods From September 2012 to September 2014,5 patients with sponge kidney stones with symptoms and secondary lesions admitted in our hospital were selected and treated by holmium laser lithotripsy under flexible ureteroscope.The postoperative clinical symptoms relief,intraoperative and postoperative complications were observed.The renal function,urinary system color Doppler and KUB plain film were reviewed regularly.Results In 5 patients with sponge kidney stones,3 cases was bilateral and 6 operations were performed.Two patients had calculus canton at UPJ,and free calculus of renal pelvis and calyces and submucous calculus of papilla were found.The stones were broken by holmium laser,and the submucous stones were cut mucosa to crush the stones.Renal function was normal at 1,3,and 7 days after surgery.The symptoms of renal colic disappeared in the patients with obstruction,and the symptoms of low back pain in other patients also decreased.All patients had stones and debris discharged by themselves.After 1,3 and 6 months of operation,the number of stones in the reexamination images of the patients decreased in varying degrees.Except for the first patient with bilateral renal stone after surgery occurred urinary sepsis,which was cured after treatment,no obvious complications were found in other patients.Conclusion Flexible ureteroscopic holmium laser lithotripsy for the treatment of sponge kidney stones can significantly reduce the patients'stone load.As long as the preoperative preparation is adequate and the operation is reasonable,it is a minimally invasive,safe and effective treatment.