一次性电子输尿管软镜治疗上尿路结石的疗效分析

Disposable digital flexible ureteroscope in the treatment of upper urinary calculi

目的探讨一次性电子输尿管软镜治疗上尿路结石的安全性和有效性。方法回顾性分析2020年7月至2021年1月南方医科大学南海医院及湛江西南医院泌尿外科采用一次性电子输尿管软镜治疗上尿路结石65例患者资料,男性41例,女性24例,年龄(43.8±8.5)岁,分析其结石大小、部位、结石清除率及并发症等资料,总结手术安全性和有效性。结果46例患者一期手术成功,19例因输尿管软镜鞘置入困难,留置双J管2周后二期手术成功。结石累计最大径线(23.3±6.8)mm,碎石时间(29.46±10.53)min;手术时间(42.18±15.35)min,术后住院时间(2.3±1.2)d。4例(6.15%)患者术后发生并发症,包括发热、血尿、腰痛等,经治疗后均顺利恢复。术后1个月结石清除率89.2%(58/65);结石直径≤20 mm组54例(83.1%),结石清除率为92.6%(50/54);结石直径>20 mm组11例(16.9%),结石清除率为72.7%(8/11);两组结石清除率比较,差异无统计学意义(P=0.053)。肾下盏结石22例,其中肾盂下盏漏斗夹角(IPA)>30°14例,结石清除率为85.7%(12/14);IPA≤30°8例,结石清除率为62.5%(5/8);两组比较,差异无统计学意义(P=0.211)。结论一次性电子输尿管软镜治疗上尿路结石安全、有效,但对于直径>20 mm、IPA≤30°上尿路结石的疗效需增加病例数进一步研究。

Objective To investigate the safety and effectiveness of disposable digital flexible ureteroscope in the treatment of upper urinary calculi.Methods A retrospective analysis was performed on 65 patients with upper urinary calculi treated with disposable digital flexible ureteroscope at Department of Urological Surgery,Nanhai Hospital of Southern Medical University and Department of Urological Surgery,Zhanjiang Southwest Hospital from July 2020 to January 2021,including 41 males and 24 females.They were(43.8±8.5)years old.The calculi sizes,sites,calculi clearance rate,and complications were analyzed,and the operation safety and effectiveness were summarized.Results Forty-six cases had successful one-stage operation,and 19 need second stage operation 2 weeks after indwelling double J tubes due to the difficulty of flexible ureteral sheath placement.The calculi's cumulative maximum diameter was(23.3±6.8)mm.The lithotripsy time was(29.46±10.53)min.The operation time was(42.18±15.35)min.The postoperative hospital stay was(2.3±1.2)d.Postoperative complications occurred in 4 patients,including fever,hematuria,lumbago,etc.,accounting for 6.15%.All the patients recovered after the treatment.One month after the operation,the calculi clearance rate was 89.2%(58/65).There were 54 patients(83.1%)in the group with calculi diameter≤20 mm,and the calculi clearance rate was 92.6%(50/54);the calculi clearance rate was 72.7%(8/11)in the 11 patients(16.9%)in the group with calculi diameter>20 mm;and there was no statistical difference in the calculi clearance rate between the two groups(P=0.053).There were 22 cases of lower calyceal calculi;among them,14 cases had an infundibulopelvic angle(IPA)>30°,and the calculi clearance rate was 85.7%(12/14);eight cases had an IPA≤30°,and the calculi clearance rate was 62.5%(5/8);there was no statistical difference between the two groups(P=0.211).Conclusion Disposable digital flexible ureteroscope is safe and effective in the treatment of upper urinary calculi,but the efficacy of>20 mm or IPA≤30°upper urinary calculi needs to be further studied by increasing the case number.