输尿管软镜治疗孤立肾单发结石的疗效分析(附27例报道)

Efficacy Analysis of Flexible Ureteroscopy for the Treatment of Renal Single Stone in Solitary Kidney(Report of 27 Cases)

目的探讨输尿管软镜治疗孤立肾单发结石的有效性和安全性。方法回顾性分析我科自2014年1月至2019年1月收治的27例孤立肾单发结石患者的临床资料。患者年龄(45.72±10.80)岁。结石直径(1.90±0.70)cm,CT值(856.72±70.33)HU。上盏结石8例、中盏结石10例、下盏结石4例、肾盂结石5例。先天性孤立肾1例,后天性孤立肾26例。所有患者术前留置DJ管2周,术中采用输尿管软镜治疗。统计分析患者术前术后血肌酐、手术时间、住院时间、Ⅰ期手术清石率、术后2周结石清除率、Ⅱ期手术率、Ⅱ期ESWL率、术后1个月结石清除率等指标及并发症情况。结果本组27例患者均由同一术者顺利完成手术。手术时间40~70 min,平均手术时间(55.74±13.82)min,住院时间2~5 d,平均住院时间(3.41±1.22)d。Ⅰ期手术清石率81.48%(22/27),术后2周结石清除率85.19%(23/27)。3例结石残留(11.11%)Ⅱ期再次接受输尿管软镜碎石治疗,1例(3.70%)结石残留予保留DJ管并行ESWL治疗。术后1个月结石清除率96.30%(26/27)。术后1 d平均血肌酐与术前相比无明显差异[(105.40±9.91)μmol/L vs.(108.31±16.72)μmol/L,t=0.7780,P=0.2201]。无严重并发症,肉眼血尿26例(96.30%)、发热4例(14.81%)、膀胱刺激症状14例(51.85%)。结论对于结石直径≤2.50 cm,结石CT值≤1000 HU的孤立肾单发结石,输尿管软镜是一种安全、有效的方法,具有创伤小、并发症少、不影响肾功能的优点,值得临床推广应用。

Objective To investigate the efficacy and safety of fl exible ureteroscopy for the treatment of renal single stone in solitary kidney.Methods The clinical data of 27 patients with renal single stone in solitary kidney admitted to our department from January 2014 to January 2019 were retrospectively analyzed.The patient's age was(45.72±10.80)years old.The stone diameter(1.90±0.70)cm,CT value(856.72±70.33)HU.8 cases were upper kidney calyces stones,10 cases were middle kidney calyces stones,4 cases were lower kidney calyces stones,and 5 cases of kidney pelvis stones.There were 1 case of congenital solitary kidney and 26 cases of acquired solitary kidney.All patients were placed in the DJ tube for 2 weeks before surgery and treated with fl exible ureteroscopy.Statistical analysis of patients with preoperative and postoperative serum creatinine,operation time,hospitalization time,stone-free rates in the one-stage operation,stone-free rates in postoperative 2 weeks,two-stage operation rate,two-stage ESWL rate,stone-free rates in postoperative 1 month and complications.Results All patients were successfully operated by the same surgeon.The operation time was 40-70 min,with an average of(55.74±13.82)min,and the hospitalization time was 2-5 days,with an average of(3.41±1.22)days.The stone-free rates in the one-stage operation was 81.48%(22/27),and the stone-free rates in postoperative 2 weeks was 85.19%(23/27).Three patients with residual stones(11.11%)were treated with fl exible ureteroscope lithotripsy in stage II,and one patient(3.70%)had residual stones were treated with keep Indwelling DJ tube and ESWL in stage II.The stone-free rates in postoperative 1 month was 96.30%(26/27).There was no signifi cant diff erence in mean serum creatinine between postoperative 1 day with preoperative[(105.40±9.91)μmol/L vs.(108.31±16.72)μmol/L,t=0.7780,P=0.2201].There were no serious complications,hematuria in 26 cases(96.30%),fever in 4 cases(14.81%),and bladder irritation in 14 cases(51.85%).Conclusion For renal single stone in solitary kidney with stone diameter≤2.50 cm,stone CT value≤1000 HU,fl exible ureteroscopy has the advantages of less trauma,less complications,and does not aff ect renal function.It was a safe and eff ective methods,and worthy of clinical application.