输尿管软镜术在拟从事特殊职业人群无症状肾结石中的应用

Efficacy of retrograde intrarenal surgery in the management of asymptomatic renal calculi in populations to engage in special occupation

目的探讨逆行输尿管软镜术治疗拟从事特殊职业人群无症状肾结石的有效性及可行性。方法回顾性分析潍坊市中医院泌尿外科2016年10月至2021年9月期间收治的20例特殊职业(预备役体检17例、海员1例、空乘人员2例)无症状肾结石患者作为研究对象。2例为双侧肾结石,18例为单侧肾结石,共22个结石肾脏,均采取逆行输尿管软镜手术。术后1~4周取出双J管并复查腹部CT评估结石清除率。结果20例患者均一期完成输尿管软镜碎石术,1例因输尿管狭窄行球囊扩张后完成手术,2例为一期双侧手术。18例20个肾脏内(90.9%)找到肾结石,包括3例肾盏憩室结石,2例肾乳头锚定结石,2例肾乳头旁锚定结石。2个肾脏内未发现结石,考虑肾实质钙化。结石平均最大直径(6.9±2.4)mm,平均手术时间为(46.3±12.9)min。术后住院时间为1~3 d,平均(1.7±0.7)d。围手术期无1例发生严重并发症。本组20例患者总体结石清除率90%(18/20),18例成功通过特殊职业体检并入职。结论逆行输尿管软镜碎石取石术治疗拟从事特殊职业人群的无症状肾结石疗效确切、快速、安全性高,可以成为这类结石手术治疗的一线选择。

Objective To evaluate the safety and efficacy of retrograde intrarenal surgery(RIRS)in the management of as⁃ymptomatic calyceal calculi in populations to engage in special occupation.Methods Clinical data of 20 patients(17 reservists,1 mariner,2 flight attendants)with asymptomatic renal calculi treated in the Department of Urology of Weifang Hospital of Tra⁃ditional Chinese Medicine during Oct.2016 and Sep.2021 were retrospectively analyzed,including 2 cases of bilateral renal cal⁃culi and 18 cases of unilateral renal calculi,altogether 22 kidneys involved.All patients received RIRS.The double J stents were removed 1~4 weeks postoperatively,and abdominal CT scan was performed.Results One-stage operations were performed in all patients,including balloon dilatation in 1 patient with ureteral stricture and bilateral RIRS in 2 patients.Calculi were suc⁃cessfully removed in 20 kidneys(90.9%),including 3 cases of calyceal diverticulum calculi,2 cases of renal papillary anchoring calculi and 2 cases of renal parapapillary anchoring calculi.Calculi were not found in 2 cases,which were suspected of renal pa⁃renchyma calcification.The average diameter of calculi was(6.9±2.4)mm,operation time(46.3±12.9)minutes,and posto-perative hospital stay(1.7±0.7)days.No serious complications occurred during the perioperative period.The overall stone-free rate was 90%(18/20),and 18 patients successfully passed the special occupational physical examination.Conclusion Retro⁃grade intrarenal surgery is a safe,effective and minimally invasive procedure in the treatment of asymptomatic calyceal calculi in the special occupational populations.