Ⅰ期置管后Ⅱ期联合输尿管鞘下输尿管硬镜处理2~3cm肾盂结石疗效分析

Clinical efficacy of presetting double J tube and using ureteral access sheath in ureteroscopic lithotripsy in the treatment of renal pelvis calculi

目的探讨输尿管硬镜钬激光碎石联合输尿管鞘治疗肾盂结石的安全性及有效性。方法回顾性分析2017年1月至2020年1月闵行分院收治的2~3 cm肾盂结石伴轻度肾积水的患者78例的临床资料。其中A组患者采用Ⅰ期置管,Ⅱ期行联合输尿管鞘下输尿管硬镜碎石(18例),B组患者采用Ⅰ期行输尿管硬镜碎石(22例),C组患者采用经皮肾镜钬激光碎石取石术(38例)。比较分析三种方法治疗肾盂结石的手术时间、Ⅰ期结石清除率、术后住院天数、住院费用和术后发热率和出血率。结果所有手术均顺利完成。手术时间A组(95±14)min,B组(106±11)min,C组(88±15)min,A组和C组差异无统计学意义(P>0.05),两者显著低于B组(P<0.05);肾盂结石Ⅰ期结石清除率A组77.78%,B组72.73%,C组84.21%,差异无统计学意义(P>0.05);A组患者术后低热2例中高热0例,B组患者术后低热5例中高热3例,C组患者术后低热8例,中高热3例,A组患者术后出现发热的例数低于B组和C组,但差异无统计学意义(P>0.05);住院天数分别为A组(2.61±0.61)d,B组(3.27±0.98)d,C组(4.58±1.08)d,A组患者住院时间显著低于B组和C组,差异有统计学意义(P<0.05)。C组术后明显出血2例,经保守治疗治愈。结论对于2~3 cm肾盂结石,合并同侧轻度肾积水的患者,采用Ⅰ期置管,Ⅱ期行联合输尿管鞘下输尿管硬镜碎石,清石率可靠,具有创伤小、住院天数少、并发症发生率低的优势。

Objective To investigate the safety and efficacy of presetting double J tube and using ureteroscopic lithotripsy combined with ureteral sheath in the treatment of renal pelvis calculi.Methods The clinical data of 78 cases of 2-3 cm renal pelvis calculi with mild hydronephrosis from January 2017 to January 2020 were analyzed retrospectively.In group A,18 patients were treated with presetting double J tube in phase I,ureteroscopic lithotripsy combined with ureteroscopic lithotripsy in phase II.In group B,22 patients were treated with ureteroscopic lithotripsy.In group C,38 patients were treated with percutaneous nephrolithotomy.The operation time,stone clearance rate,hospitalization days,hospitalization cost,postoperative fever rate and bleeding rate were compared and analyzed.Results All the operations were successfully completed.The operation time of group A was(95±14)min,group B(106±11)min,group C(88±15)min,there were significant differences between group B compared with group A and group C(P<0.05).The stone removal rate of stage I pyelolithiasis in group A was 77.78%,group B was 72.73%,and group C was 84.21%,the differences were not statistically significant(P>0.05).There were 2 cases of low fever and 0 case of high fever in group A,5 cases of low fever and 3 cases of high fever in group B,8 cases of low fever,3 cases of moderate high fever in group C,the rate of postoperative fever in group A was lower than that in group B and group C,but the differences were not statistically significant(P>0.05).The hospitalization days in group A were(2.61±0.61)d,in group B were(3.27±0.98)d,in group C were(4.58±1.08)d,and the hospitalization days in group A were significantly lower than that in group B and group C,the differences were statistically significant(P<0.05).In group C,there were 2 cases of bleeding,which were cured by conservative treatment.Conclusion For the patients with 2-3 cm renal pelvis calculi and mild hydronephrosis,presetting double J tube and using ureteroscopic lithotripsy combined with ureteral sheath is reliable,with the advantages of less trauma,fewer days in hospital and low incidence of complications.