输尿管软镜治疗肾盂肾下盏漏斗夹角≤30°肾下盏结石的诊治体会(附58例报告)

Diagnosis and treatment of lower calyceal calculi with infundilbulopelvic angle≤30°by ureteroscopy(58 cases)

目的探讨输尿管软镜碎石术(RIRS)治疗肾盂肾下盏漏斗夹角(IPA)≤30°肾下盏结石的手术方法和技巧。方法回顾性分析该院泌尿外科2018年1月-2021年2月58例行RIRS治疗IPA≤30°肾下盏结石患者的临床资料。其中,左侧31例,右侧27例;男33例,女25例。结果58例IPA≤30°肾下盏结石患者中,54例通过各种方法最终进入肾下盏并找到结石,4例因盏颈狭长无法进入肾下盏而改为经皮肾镜碎石术(PCNL)。54例患者中,41例行结石移位碎石;11例患者因结石负荷大,无法移位,先将其碎成大块后再行移位碎石;1例女患者因结石边缘光滑、体积较小,输尿管管腔整体较宽,用套石篮直接将结石连同输尿管通道鞘(UAS)缓慢拖出体外;1例肾下盏盏颈狭窄患者,经钬激光切开后顺利进入并移位碎石。54例成功手术的患者中,行一次碎石取石手术者48例,二次碎石取石手术者6例;手术时间32~135 min,平均(65.4±10.1)min;术后住院时间2~5 d,平均(3.5±1.3)d。结论在排除肾下盏盏颈狭长并配合多种技巧辅助下,RIRS可作为IPA≤30°且结石直径≤2.0 cm肾下盏结石的首选治疗方法,其安全、有效,并发症少,痛苦轻,住院时间短,患者易接受。

Objective To explore the operative methods and skills of retrograde intrarenal surgery(RIRS)for the treatment of lower calyceal calculi with infundilbulopelvic angle(IPA)≤30°.Methods From January 2018 to February 2021,58 cases of RIRS were analyzed retrospectively.There were 31 cases of left kidney,27 cases of right side;33 cases of male,25 cases of female.Results 54 of 58 patients with IPA≤30°lower calyceal calculi were able to enter the lower calyces of the kidney and find the calculi by various methods,and 4 patients were changed to percutaneous nephrolithotripsy(PCNL)because the calices were too long and narrow to enter the lower calyces of the kidney.41 cases were treated with stone shifting lithotripsy;11 patients were unable to move because of the heavy load of stones,and the stones were broken into large pieces before being moved.1 female patient had smooth edge,small volume and wide ureter cavity,one case of lower calyceal neck stenosis was successfully treated by Holmium laser incision and lithotripsy.One case of lower calyceal neck stenosis was treated with holmium laser.Among the 54 cases of successful operation,48 cases were treated with one-time lithotripsy and 6 cases with two-time lithotripsy.The operation time was 32~135 min,the average operation time was(65.4±10.1)min.The postoperative hospital stay was 2~5 d,the average hospital stay was(3.5±1.3)d.Conclusion RIRS is the first choice for the treatment of lower calyceal calculi with IPA≤30°and the stone diameter≤2.0 cm with the exclusion of the narrow neck and the assistance of various techniques,the utility model has the advantages of safety,effectiveness,less complication,less pain,short hospitalization time,easy acceptance by patients.